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NTISEPSIS 



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Book N 6 



^^M 11 1909 




SOME 



OF THE world's GREATEST SURGEONS AND BACTERIOLOGISTS. 



Antisepsis and Antiseptics. 



— BY — 



Cliarle^ Milton Bucliaiiaii. M.I>.. 

PROFESSOR OF CHEMISTRY, TOXICOLOGY AND METALLURGY. 
NATIONAL UNIVERSITY, WASHINGTON, D. C. 



WITH AN 

IISTTi^OIDTJOTIOn^ 

— BY — 
Professor Augustus C. Bernays. 



THE TERHUNE COMPANY : 

Publishers of Medical Books, Newark, N. J.. 

1805. 






COPYRIGHTED 1895. 



DEC 15 19G2 




//^mooacT/o// By A- ^oU/^^Afo, 2^.1^. 9 f 
PROE /uGUSWS C//ARLES BER/i/AYd. 

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CONTENTS. 

CHAPTER I. 

History — From Earliest Times to the Beginning of the 

Christian Era, ------ 3 

CHAPTER 11. 

History — From the Christian Era to the Beginning of the 

Eighteenth Century, - - - - ' - 12 

CHAPTER HI. 

History — From the Beginning of the Eighteenth to the First 

Six Decades of the Present Century, - - - 23 

CHAPTER IV.. 
History — From the Advent of Lister to the Present Time, 36 

CHAPTER V. 
The Products of Vital Cellular and Bacterial Activity, - 46 

CHAPTER VI. 
Infection, Susceptibility and Immunity, . - - ^g 

CHAPTER VII. 
Antiseptics and Their Relative Value, - - - 81 

CHAPTER Vin. 
Antiseptics — Their Use and Value in General Medicine, - 220 

CHAPTER IX. 
Antiseptics — Their Value and Use in Surgery, - - 234 

CHAPTER X. 

Antiseptics — Their Value and Use in Obstetrics and Gyne- 
cology, - - - - - - - 257 

CHAPTER XT. 

The Essentials of Antisepsis and Asepsis, - - - 273 



INDEX. 



Acelanilid, 94. 
Acetic acid, 49, 95, 96. 
Acetic fennentation, 33. 
ricetone, 96. 

Acetyl-para-amido-saiol, 187. 
Acquired immunity, 64, T^, 74, 75 

76, 77. 78, 79, 80, 81. 
Acrolein, 213. 

Action of antiseptics, 92, 93, 94. 
Action of blood and tissues upon 

parasitic organisms, 222. 
Adeps lanac hydrosus, 161. 
Advantages of antiseptics, 38, 39. 
Alabastrine, 164. 
Alcohol, 97. 

Alkaloidal bases of dead body, 55, 
Alkaloidal bases of decomposed 

brains, 56. 
Alkaloidal bases of decomposed 

blood, 54. 
Alkaloidal bases of decomposed 

meat, 55. 
Alkaloidal bases of liver-sausage , 

55- 

Alkaloidal bases of moldy corn- 
meal, 56. 

Alkaloidal bases of poisonous 
cheese, 56. 



Alkaloidal bases of putrid yeast, 

54. 
Alumn, 97. 
Alumnol, 98. 
Aluminic acetate, 97. 
Aluminic chlorid, 97. 
Ammido - para - acet - phenetidin , 

169. 
Ammonia, 99. 
Ammonic carbonate, 99. 
Ammonic chloride, 99. 
Ammonic fluo-silicate, 99. 
Ammonic ichthyo - sulphonate, 

208. 
Ammonic sulphate, 99. 
Anaerobic germs, 48. 
Analgessin, 102, 103. 
Ancient system of medicine, 7. 
Anhy dro -ortho-sulphaminic- be n- 

zoic acid, 181. 
Anilin dyes, 100. 
Anilin oil, loi. 

Animal alkaloids, 31, 45, 50, 51. 
Anisic acid, loi. 
Annidalin, 10 1. 
Anthrarobin, 102. 
Anthrax, 41, 42. 
Anthrax spores, 130, 131, 133. 



VII 



Anthrax poison formed by germs, 

Anticholerine, 42, 57. 

Antiiebrin, 94. 

Antipyrin, 102, 103, 339, 346. 

Antisepsin, 103. 

Antisepsis, 5, 8, 81. 

Antisepsis among Egyptians, 9, 
10, II. 

Antisepsis among Greeks, 11. 

Antisepsis among Jews, 1 1 . 

Antiseptics for iniernal and exter- 
nal use, 227, 228. 

Antiseptics, mode of action, 92, 93 

94 

Antiseptics, value and use in gen- 
eral medicine, 220. 

Antiseptics value and use in ob- 
stetrics and gynecology, 257. 

Antiseptics, value and use in sur- 
gery, 234. 

Antiseptol, 103. 

Antizymotic, dry, 6. 

Arbulin, 103, 104, 105, 155. 

Argent nitrate 197. 

Argol, 212. 

Aristol, 105, 346. 

Arsenious acid, 105. 

Asaprol, 106 

Asepsis, 6, S;^, 

Asepsis dependent upon antisep- 
sis, 83. 

Aseptln, 106. 

Aseptol, 106, 107, 208. 

Assyrians, 9. 

Attenuated cultures, inoculation 
of, 42. 



Auric chlorid, 153. 

Bacillus sub tills, 141. 

Bacillus tetanus, discovery of, 43. 

Bacterial proteids, 50. 

Bacteriology in diagnosis, 223. 

Baric chlorid, 107. 

Bases of dead body, 55. 

Benzene, 107. 

Benzoate of beta-naphtol, 109. 

Benzoate of guaiacol, no. 

Benzoate of eugenol, no. 

Benzoic acid, 108. 

Benzoic sulphimide, 181. 

Benzol, 107. 

Benzo-naphtol, 109. 

Benzo-phenoncide, iia 

Benzosol, no. 

Benzoyl-eugenol, 1 10. 

Benzoyl-guaiacol, no. 

Benzoyl sulphonic-imide, 181 

Betanaphtol, 156, 165. 

Betol. III. 

Bichloride of mercury, 132. 

Birth of antiseptic era, ^y. 

Bismuth, subnitrat., 346. 

Blood, action upon germs, 63, 6(/ 

67,68,69,70,71,72,73,84. 
Blood serum therapy, 73, 84, 85. 
Blood serum, e:ermicidal power. 

63. " ' 

Boiling point, effect on putrefac- 
tion, 7. 
Boracic acid, 112. 
Boric acid, 112, 345; 
Borax, in. 



VIII 



Borneol, 212. 

Brains, alkaloidal bases of decom- 

posiLg, 56. 
Brewer, first, 8. 
Bromin, 129. 
Bromoform, ii^. 
Bromol, 115. 
Bromophenol, 115, 130= 
Butyric acid, 49, 116. 
Butyric acid fermentation, ^3- 

Calcic beta-naplitol-alplia-mono- 

^^sulphonate, 106. 
Calcic chloiid, 116. 
Calcic hydroxid, 116. 
Calcic hypochlorite, 116. 
Calcium salicylate, 118. 
Camphene, 212. 
Camphor, 118. 
Camphylene, 164. 
Carbolic acid, 32, 33, 43, 345. 
Carbonate of ethyl and phenyl, 

151. 
Carvacrol, 126. 
Caustic soda, 199. 
Cell products, 45, 47, 48, 49. 
Cell products, effects in causation 

of disease, 45. 
Cheese, poisonous, 54. 
Chinese, 9. 
Chinoline, 126. 
Chloral, 129. 
Chlorate of potash, 174, 
Chloride of lime, 116, 129. 
Chlorine, 127. 
Chlorine in internal medication, 

129. 



Chloroform, 130. 

Chlorphenol, 130, 

Chloro-phenol, [30. 

Cholera, 43. 

Cholera bacillus, 43. 

Cholera, discovery of germs, 43. 

Cholera, poison elaborated by, 

56. 

Cholera stools products, 54. 

Chrysarobin, 131. 

Chromic acid, 131. 

Cinnamyl-eugenol, 150. 

Circumcision, 11. 

Citric acid, 132. 

Civilization of ancient Egyptians, 

10. 
Classification of micro-organisms, 

25, 43, 49* 
Cleaning of patient, 258. 
Cleaning of instruments, 290. 
Coal tar, 27, 120. 
Coal tar, preservative properties, 

27, 120. 
Coal tar saponine, 120 
Coffee in'usion, 132. 
Cold, preservative effect?, 6. 
Cold, effects on germs, 86, 87. 
Columbus, 4. 

Condition for cell life, 315. 
Contagium animatum of Pasteur, 

35- 
Corrosive sublimate, 132, 135,345 
Creolin, 142. 
Creosol, 144. 
Creosot, 144. 
Creosotal, 144. 



IX 



Cresalo], 169. 

Cresin, 145. 

Creso), 144, 146. 

Cresoliodide, 146. 

Cresylic acid, 147, 

Cupric chlorid, 147. 

Cyanide of zinc and mercury, 346. 

Cymene, 212, 

Dark ages, 13. 
Decomposing blood, 54. 
Decomposing meat, 55. 
Decomposition, organic, 6. 
Decreased mortality of antiseptics, 

38, 39. 

Dehydro-di-methyl-phenyl-pyra- 
zine, 102. 

Dependence of asepsis upon anti- 
sepsis, S^. 

Dermatol, 147. 

Disinfection oil, 188. 

Desozy-alizarin, 102. 

Dessication, effect on germs, 90, 
91. 

Development of germs, 85. 

Eiapterin, 148. 

Di-methyl-oxy-quinizine, 102. 

Diphtheria, 43. 

Diphtheria, discovery of germ, 43. 

Diplococcus pneumoniae, 40, 42. 

Discovery of micro-organism, 19. 

Discovery ot yeast plant, 28. 

liiscovery of spores, 31. 

Disinfection, control disinfectious 
diseases, 222. 

Disinfectol, 148. 



Di - iodo - para-phenyl-sulphonic 

acid, 205. 
Di-iodo-resorcin-mono-sulphonic 

acid, 172. 
Di - iso-butyl-ortho-cresol- iodid, 

151. 
Di -methyl-benzene, 218. 
Drainage, 308. 
Drainage, first attempts, 17, 24, 

26. 
Dry heat, effect on germs, 90, 91. 
Dry pulverulent dressing, 314. 
Dupre, 53,. 54. 

Earliest record of antiseptic prac- 
tices, 9. 

Earliest record of medicine, 7. 

Effect of ingestion of putrid mat- 
ter, 54. 

Egyptian civilization, 10. 

Egyptian medicine, 10. 

Egyptian priest-physicians, 10, 
II. 

Fgyptians, 9, 10, 11, 

Elementary principles of modern 
midwifery, 265. 

Electricity, effect upon germ?, 91, 
92. 

Embalming, 9, 10. 

Embalming, a crude attempt at 
asepsis, 10. 

Essentials of antisepsis and asep- 
sis, 273. 

Essential oils, 149. 

Ether, 149. 

Eucalyptene-di-chlorid, 150. 



Eucalypteol, 150. 
Eucalyptol, 140. 
Eugenic acid, 150. 
Eugenol, 150. 
Euphoriiij 150. 
Europhen, 151. 
Exalgine, I5r. 

Fatty acids, 49. 

Fermentation, 4, 5, 8, 20, 22, 30. 

Fermentation, acetic, 33. 

Fermentation, entyric, ^3- 

Fermentation, putrefactive, 5. 

Fermentation, vinous , 33. 

Fermentation, Bell's theory, 27. 

Fermentation, Gay Lussac's the- 
ory, 28, 29. 

Fermentation, Mayow's theory, 
27. 

Ferrichlorid, 152. 

Ferrous sulphate, 152. 

Feuerbringer's method, 262. 

For alalia, 152. 

Formic acid, 152. 

Fowler's solution, 173. 

Gallic acid, 152. 

Germ effect in causation of dis- 
ease, 45. 

Germ products, 45, 48, 49, 50. 

Germ theory of disease, 33, 34, 35 
37, 44, 46, 47. 

Germicidal effect, 81, 82. 

Germicidal power of blood not 
due to phagocytes, 67. 

Glanders, 22. 



Glycerin, 153. 

Gluside, 181. 

Glucusimide, 181. 

Gold chlorid, I53. 

Gonococcus, discovery of, 41. 

Gonorrhea, 41. 

Gravitation, 3. 

Greeks, 11. 

Guaiacol, 153. 

Guards against gastric-intestinal 

infection, 61. 
Guards against infection through 

blood channels, 61, 
Guards against infection through 

lymph channels, 61; 



Heat as sterilizer, 285. 
Helenin, 154. 
Heliotropsii, 172. 
Hydrochinone, 155. 
Hydrofluoric acid, 1 56. 
Hydrofluosilicic acid, 1 56. 
Hydrogen dioxid, 155. 
Hydrogen peroxid, 155, 346. 
Hydronaphtol, 156, 346. 
Hydroquinone, 104, 155. 
Hydroxyl, 155. 
Hydroxyl-benzene, 118. 

Iceland, 4. 

Ichthyol, 208. 

Immunity conferring albumose of 

anthrax, 56. 
Immunity from disease, 62, 63, 64. 
Immunity, natural, 64, 65. 



XI 



Immunity, artificial, 64, 73, 74, 75 
76.77,73,79,80,81. 

Immunity, racial, 64. 

Indol, 157. 

Infection by inhalation, 60, 

Infection through circulatory sys- 
tem, 60. 

Infection through lymphatic sys- 
tem, 60. 

Infection through intestinal mu- 
cous membrane, 59. 

Infection through respiratory mu- 
cous membrane, 60 

Infection through skin, 59. 

Influenza, 43. 

Influenza, discovery of germ, 43. 

Ingestion of putrid matter, effect, 

54. 
Iodide of potash, 175. 
Iodine, 129 157, 345. 
Iodine in internal medication, 

129. 
lodin-trichlorid, 157. 
lodo-boro-thymolate of zinc, 103. 
lodo - di - iso -butyl-ortho-cresol, 

151. 
Iodoform, 158, 345. 
lodol, 159, 346. 
lodophenacetine, 159. 
lodophenin, 159. 
lodozone, 160. 
Irrigation, 28, 303. 
Iso-naphtol, 165. 
Izol, 160. 

Jews, II. 



Jewish priest physicians, 11. 
Jewish vandage in Egypt, 11. 

Koch's discovery of pathogenic 
germs, 40. 

Koch*s discovery of specific origin 
of anthrax, 41. 

Koch's discovery of bacillus an- 
thracis, 41. 

Koch's treatise on traumatic in- 
fectious diseases, 41. 

Koch's discovery of typhoid germ, 
42. 

Koch's discovery of cholera spiril- 
lum, 43. 

Koch's inoculations of attenuated 
cultures, 42. 

Koch's introduction of mercuric 
chlorid, 42. 

Koch's indroduction of solid cul- 
ture media, 49. 

Koch's introduction of plate meth- 
od for pure cultures, 49. 

Koch's introduction of geiain 
media as a means of classifica- 
tion of germs, 49. 

Lactic acid, 161. 

Lanolin, 161. 

Laurinol, 118. 

Lead chlorid, 160. 

Lead tiophen-suiphonate, 215. 

Leprous tubercle, 41. 

Leucomaines, 45, 50, 51, 52, 230. 

Lime water, 116. 

Liquor antisept'cus, 142. 



XII 



Listerism, 267. 

Lister's extension of discovery of 

Schwann and Pasteur, 40. 
Lister's renewed allegiance to 

carbolic acid, 43. 
Lister's surgical dressing, 41. 
Losopban, 162. 
Lysol, 162, 263. 
Lunar caustic, 197. 

Malachite green, 100. 

Malarial disease, 42. 

Malic acid, 163. 

Meat, poisonous, 52. 

Medicine among early Egyptians, 
10. 

Mercury, 163. 

Mercuric chlorid, 132, 345. 

Mercuric chlorid action as an an- 
tiseptic, 264. 

Meta-di-hydro-oxy-benzene, 179. 

Meta-di-oxy-benzene, 179. 

Methyl-blue, ico, 163, 177. 

Methyl-yellow, 100 

Methyl-violet 100, 177. 

Methyl-acet-anilid, 151. 

Methyl pyrocatechin, 153. 

Methylene-blue, 100. 

Method of embalming, 9. 

Method of staining, 49. 

Methozin, 102. 

Microbes, 4. 

Micro-organisms causing morbid 
conditions, 226. 

Micro-organisms, classification of 
43. 



Modern progress in medicine, 12. 

Moist heat, effect on germs, 87, 
SS, 89. 

Monochlorphenol, 130. 

Morbid conditions caused by mi- 
cro-organisms, 22c. 

Morphia hydrochlorate, 164. 

Mortality, decrease due to antisep- 
sis, 38, 39. 

Moldy commeal, effect of, 56. 

Mustard, 346. 

Mustard as a means of steriliza- 
tion, 338, 339. 

Napthalene, 164. 

Naphtalin, 164. 

Naphtalol, in. 

Naphtol, 165, 321. 

Naphtosalol, in. 

Naphtyl-a^cohol, 165. 

Natural processes combated, 8. 

Nature lost sight of by early phy- 
sicians, 7, 

Nature, healing power of, 13, 15, 
16, 17, 20, 156. 

Nitric acid, 166. 

Nitrous acid, 166. 

Norsemen, 4. 

Office of practitioner of antiseptic 

surgery, 6. 
Oil of mustard, 339. 
Oil of turpentine, 339. 
Oleic acid, 166. 
Olive oil, 167. 
Organic decomposition, 6. 



XIII 



Ortho-bromo- phenol, 115. 
Ortho-cresol iodid, 146. 
Ortho-phenol, 106. 
Ortho - phenol - sulphonic acid, 

100. 
Ortho-phosphoric acid, 171. 
Oxalic acid, 167, 264. 
Oxychinasep^ol, 146. 
Oxygea, 6, 167. 

Para-amido-anisol, 213. 
Para-cresolal, 169. 
Para-cresolic salicylate, 169. 
Para-dioxy benzene, 155. 
Para-mono-ace tanilid, 103. 
Para - mono - brom-phenyl-aceta - 

mid, 103. 
Pasteur's investigation, an aid to 

Lister, 34, 40. 
Pasteur's investigation, result of, 

34. 
Peroxide of hydrogen, 263, 264. 
Phagocytosis, 45, 63. 
Phenazon, 102. 
Phenic acid, 118. 
Phenocoll, 169. 
Phenol, 118. 
Phenolid, 170. 
Phenosalyl, 170. 
Phenol sulfonic acid, 208. 
Phenyl-acetamid, 94. 
Phenyl-alcohol, 118. 
Phenyl-ethylic-urethane, 151. 
Phenyl-dimethyl-pyrazolon, 102. 
Phenyl-hydrate, 118. 
Phenyl-hydroxid, 118. 



Phenyl-salicylate, 186. 

Phenyl-urethane, 151. 

Phyloxera, 34, 

Picrol, 172. 

Piperonal, 172. 

Plasmodium malarise, 42. 

Pneumotosine, 57. 

Poisoning, acute alkaloidal, 230. 

Poisonous cheese, 54. 

Poisonous products of germs, 57, 

58. 

Poisonous sausage, 53, 54. 
Potassic acetate, 173. 
Potassic arsenite. 173. 
Potassic bromid, 173. 
Potassic carbonate, 174. 
Potassic chlorate, 174. 
Potassic chromate, 174. 
Potassic cyanid, 174. 
Potassic di-chromate, 173. 
Potassic hydroxid, 175. 
Potassic iodid, 175. 
Potassic permanganate, 176,264. 
Predisposition of disease, 61. 
Preparation of dressing, 293. 
Preparation of hands, 301. 
Preparation of ligatures and su- 
tures, 296. 
Preparation of sponges, 298. 
Priest-physicians of Egypt, 10, 11. 
Priest-physicians of Hebrews, 1 1 . 
Primitive medicine, 7, 8. 
Principia of Newton. 4. 
Propionic acid, 49. 
Ptomaines, 45, 50, 51, 52, 230. 
Ptomaines, determination of 



XIV 



chemical nature, 53. 

Ptomaines, nature of, 56. 

Puerperal infection, causes of, 
271. 

Putrefaction, 48, 29. 

Putrefaction, germ theory of, 5. 

Putrefaction but a form of fermen- 
tation, 8. 

Putrefactive alkaloids, 50,51. 

Putrefactive fermentation, 6. 

Putrefactive germs, 6. 

Putrid matter, effect of ingestion, 

54. 
Putrid matter, chemical nature of 

poisonous principles, 54. 
Putrid yeast, 54. 
Pyoktanin, 100, 177. 
Pyroligenous acid, 96. 
Pyrozone, 179/ 
Pyrrol, 159. 

Quickine, 178, 
Quinine, 179. 
Quinol, 155. 
Quinoline, 126. 

Relapsing fever, 41, 

Relapsing fever germ, discovery 
of, 41. 

Relative value of various germi- 
cidal agents, I34e 

Renaissance, 13. 

Resinol, 180. 

Resorcin, 179. 

Resorcinol, 179. 

Resopyrin, 179. 



Retinol, iSo. 
Rosanilin, 100. 
Rosinol, 180. 

Saccharine, 187. 

Saccharomyces cerevisiac, 6. 

Salacetol, 182. 

Salicylate of phenol, in. 

Salicylate of phenocoll, 186. 

Salicylacetol, 182. 

Salicylic acid, 183. 

Salicylamid, 182. 

Salinaphtol, in. 

Salocoll, 169, 186. 

Salol, III, 186, 321, 346. 

Salophen, 187. 

Salt, 199. 

Sanitas, 188. 

Saprol, 188. 

Saijsage poisons, 53, 54. 

Sennine, 171, 189, 218, 319, 321, 

326, 328, 344, 345- 
Sepsine, 31, 54. 
Sepsis, 6. 
Silver nitrate, 197. 
Skatol, 198. 
Smoke, 198, 
Soda, 199, 286. 
Sodic carbonate, 199. 286. 
Sodic chlorid, 199, 287. 
Sodic di-iodo-salicylate, 200. 
Sodic di-thio-salicylate, 200. 
Sodic hydroxid, 199. 
Sodic meta-borate, 202. 
Sodic paracresotate, 2co. 
Sodic salicylate, 185. 



XV 



Scdic silico-fluorid, 1*56. 

Sodic sozoiodolate, 200. 

Sodic sulphite, 201. 

Sodic sulpho-carbolate. 201. 

Sodic tetra-borate, 112. 

Sodic thiophen-sulphcnate, 202. 

Sodic thio-sulphate, 202. 

Sodium ichtyo-sulphonate, 208. 

Sodium thiophen-sulphonate, 215. 

Solocol, 204. 

Soluto], 203. 

Sozal, 204. 

Sozolic acid, 106, 208. 

Sozoiodol, 204. 

Spirochete obermeieri, 41. 

Spores, 31, 41. 

Spores, Cohn and Koch's investi- 
gation, 41. 

Spores, Robin and Perty's, 31. 

Staphylococcus pyogenes albus, 
258, 259, 261, 262. 

Staphylococcus pyogenes aureus, 
140, 141, 259, 261, 262. 

Staphylococcus pyogenes citrus, 

258. 

Steresol, 206. 

Sterilization of dressing, 258, 293. 

Sterilization of hands, 301. 

Sterilization ot instruments, 258, 
290. 

Sterilization of ligatures and su- 
tures, 296. 

Sterilizaiion of sponges, 298. 

Sterilization of wound, 288. 

Streptococcus pyogenes, 258. 

Styraccl, 207. 



Styron, 207. 

Subgallate of bismuth, 147. 
Sulphaminol, 207. 
Sulphaminol creosote, 208. 
Sulphaminol eucalyptol, 208. 
Sulphaminol guaiacol, 208. 
Sulphaminol menthoi, 208. 
Sulpho-carbolic acid, 106, 208. 
Sulphonic acid, 106. 
Sulphuric acid, 209. 
Sulphuric dioxyd, 209. 
Sulphuric acid, 210. 
Sulphurous acid, 31, 209. 
Sulphurous acid gas, 209, 211. 
Suppuration, 227. 
Susceptibility to disease, 62. 

Tannic acid, 211. 

Tannine, 211. 

Tartaric acid, 212. 

Tarwater, 27, 28. 

Temperature, effect of variations 

on germs, 86. 
Terebene, 212. 
Terpilene, 212. 
Terpine, 213. 
Tetanin, 56. 
Tetanus, 43, 45. 
Tetanus, discovery of germ, 4^. 

56. 

Tetanus poison elaborated, 56. 
Tetra-borate of sodium, 112. 
Tetra-hy dro-para-chinonisol ,213. 
Tetra-hydro-para-methyl-oxy-chi- 

nolin, 213. 
Tetra - methylo - diapsido-benzo - 



XVI 



phenoncide, no. 

Tetra-iodo-pyrrol, 159. 

Tetra-methy -thionin, 162. 

Thalline, 213. 

Thilanine, 213. 

Thiol, 214. 

Thiophen, 215. 

Thiophen-di-iodid, 215. 

Thio-oxy-diphenylamin, 207. 

Thio-resorcin, 215. 

Thymol, 216. 

Tinchlorid, 217. 

Tobacco-smoke, 217. 

Toxalbumen, 50, 230. 

Toxines, 50, 51. 

Tri-brom methane, 114. 

Tri-brom-phenol, 115. 

Tri-chlor-aldehyde, 127. 

Tri-chlor-methane, 130. 

Tri-chlor-phenol, 130. 

Tri-iodo-methane, 158. 

Tri-iodo-meta cresol, 162. 

Tuberculin, 42, 57. 

Tuberculosis, 42. 

Tuberculosis, discovery of bacil- 
lus of, 42, 43. 

Tumenol, 217. 
Typhoid bacillus, 141. 
Typhoid fever, 42, 43. 



Typhoid fever germ, discovery of,. 
42. 

Typhoid bacillus poison elaborat- 
ed, 56. 

Typhotoxines, 56, 57. 

Tyrotoxicon, 56. 

Universal gravitation, 3. 

Valerianic acid, 49, 217. 

Vinegar, 96. 

Vinous fermentation, 33. 

Virtue ot antiseptic principles, 8. 

Washing soda, 199. 

Woodvinegar, 96. 

Wounds, treatment of, 37, 38. 

Xylene, 218. 
Xylol, 218. 

Yeast plant, 6, 28. 

Zinc boro-thymo-iodid, 100. 

Zinc chlorid, 218. 

Zinc mercuric cyanid, 218. 

Zinc sozoiodolate, 219. 

Zinc sulphate, 219. 

Zinc sulpho-carbolate, 219. 

Zinc sulphydroxid, 220. 



ANTISEPSIS AND ANTISEPTICS. 

I. — History. 

From Earliest Times to the Beginning of the 
Christian Era. 



No great discovery, no epoch-making invention is or 
ever has been the product of one brain. Inklings of the 
truth have illumined the minds of others than the so- 
called discoverers or inventors; only in the ripeness and 
fullness of time is the actual birth of the fact culmi- 
nated and then by some one vrho, standing head and 
shoulders above the common throng, perceives the light 
and enlightenment of coming ages and proclaims the 
truth to his fellow man. Newton was not the first to ob- 
serve that all unsupported bodies fell earthward and not 
skyward, nor indeed was he the first to suspect the 
existence of that mutual attraction between all matter 
of the univer e which we term universal gravitation. 
This had been suspected and supposed by philosophers 
for ages, but Newton first elucidated and demonstrated 
the primary laws by which its action was governed — 



this alone was sufficient to render his '*Principia" im- 
mortal. Columbus was not the first individual to suspect 
the existence of a new world, nor indeed to actually dis- 
cover it; others had gone before him, others had been 
as brave and daring, others strong in the courage of 
their own convictions had accomplished as much as he, 
but the time was not ripe, the world was not ready to 
profit by their works until the coming of Columbus, 
who owed so much to the prior discoveries of the 
brave and hardy Norsemen — for he had undoubtedly 
made himself familiar with their deeds and discoveries 
during his voyages to Iceland. It was the good fortune 
of . Columbus to have his discoveries followed up and 
developed by others than himself. Just so Lister is 
neither the discoverer nor inventor of antisepsis, though 
to his work, to his investigations and to his tireless 
energy the world owes a greater debt of gratitude than 
to any other single individual. So then, mindful of 
the fact that Lister was not the discoverer of the 
agency of microbes in the causation of fermentation, 
putrefaction, still as the originator and elaborator of 
the first well defined and systematic method of com- 
bating putrefactiv fermentation he rendered such ser- 
vice to mankind as to hand his name down to pos- 
terity as that of one to whom we owe an incalculable 
debt of gratitude. It matters not that his methods have 
been and will probably yet be radically modified, the 
broad and general principles upon which they are 
founded remain the same, and indeed will probably en- 
dure as long as surgery is a branch of the healing art. 



Hence, though true antiseptic surgery is much older 
than Lister himself, this can in nowise detract from the 
debt which humanity owes to him. 

This subject, involving as it does the history of 
progress in all branches of medical science and intimate- 
ly associated with the life history of the theories of 
fermentation as well as the discovery and development 
of the microscope, is a most voluminous one and must 
be traced by degrees and stages. 

Fermentation and putrefaction are strictly analogous 
processes or conditions, induced by the presence of 
minute, living organisms, which highly complex organic 
bodies undergo when subjected to proper conditions of 
heat, moisture and atmosphere^ It has been satisfac- 
torily demonstrated that putrefaction and fermentation 
only supervene when particles or organisms from with- 
out gain access to the putrefying or fermenting mass, 
whether that be dead or living tissue. This germ 
theory of putrefaction is the only view at the basis of 
antiseptic surgery and of which the exhibition of anti- 
zymotic drugs, or antiseptics, is only one feature. Then 
antisepsis consists of such management of a case as to 
prevent the occurrence of putrefaction in any part con- 
cerned. When this has been attained, surgery becomes 
something entirely different from what it used to be and 
both injuries and diseases formerly regarded as formida- 
ble or hopeless, progress surely and quietly toward re- 
covery. This germ theory declares that the putrefaction 
of organic substances under so-called atmospheric in- 
fluence is net effected, as formerly supposed, by the 



oxygen of the air but by living organisms derived from 
germs floating in the air or as a constituent of dust, the 
first step towards the establishment of this theory was 
the discovery of the yeast plant (Saccharomyces cerevi- 
sise) by Cagniard de la Tour in 1836. Then we may un- 
derstand by the term sepsis the existence of a condition 
in which infectious or putrefactive germs are present, 
asepsis, the entire absence of such germs and antisepsis 
the condition secured by any method whereby the 
growth and fermentative action of these peculiar and 
lower forms of organic life are more or less impeded, 
whether they are totally destroyed or simply rendered 
innocuous. An antiseptic or antizymotic drug is one 
which has the power of preventing putrefactive decom- 
position and whose power is evidenced by the ability 
to prevent the development of bacteria or micro-organ- 
isms in a medium suitable or favorable to their growth. 

It then becomes the office of the practitioner of anti- 
septic surgery to withdraw all obstacles to those opera- 
tions of Nature which naturally tend to become repara- 
tive in efliect, since it is nature who heals the wound, 
while the surgeon prevents any interference with her 
normal efforts to that effect. 

The methods of preventing organic decomposition 
depend entirely upon the removal of some one or more 
of the conditions necessary to the accomplishment of the 
process, no matter by what means effected, for instance, 
by the extreme elevation or depression of temperature. 
The preservative effects of cold are well known; ani- 
mals have been found undecomposed, in the ice of Sibe- 



ria, beloDging to extinct species and which must have 
been embalmed and enveloped in the ice for ages. A 
boiling temperature coagulates albumen, kills organisms 
and arrests putrefaction. These two operations are 
probably the most familiar and common of the processes 
by which antisepsis may be secured, but are not alto- 
gether adapted for surgical use, for reasons which are 
obvious. With this brief preface we may proceed to the 
consideration and development of the subject in hand. 
The most remarkable characteristic of the present 
age is its desire to connect itself with preceding ages; 
to learn how the things, which now are, grew and the 
origins from which they sprang. In science as else- 
where, one discovery grows out of another and cannot 
appear without its proper antecedent. In the earliest 
times of which we have any recorded history, mankind, 
as now, had recourse to the skill and art of the phy- 
sician, for indeed, medicine is probably as old as man 
himself. But naturally the system of medicine then in 
vogue was somewhat crude and ineffectual as compared 
with the status of the profession of the present day. 
Then, and indeed until comparatively recent times, the 
sole aim and object of the physician seemed to be the 
use of substances which would make a wound heal, 
make flesh grow and m^ake it firm, to m.ake a good ci- 
catrix and to m^ake a good recovery, as though the phy 
sician himself could exercise creative power. Amid all 
of these efforts nature was lost sight of, as was also the 
parts and functions which she must, and she alone can, 
perform in the healing of any wound. No attention 



8 

was given to the wound and its natural tendency to heal 
if uninterfered with; all natural tendencies were looked 
upon as vicious and as something to be combated. 
Nevertheless some bright minds, from time to time, re- 
alized the undesirabilily of interference on the part of 
the physician or surgeon and protested against the 
methods in vogue in no uncertain tones. This and this 
alone is the chief virtue of antiseptic principles that the 
natural operations of recuperation and repair are al- 
lowed to progrsss absolutely free from any extraneous 
or inhibiting condition. 

Putrefaction is but one form of fermentation, hence 
the history of antisepsis and antiseptic surgery is in- 
timately associated y^iih that of fermentation. We 
have no positive account of the first brewer but from 
history we glean the fact that his art must have been 
practiced and its products appreciated more than two 
thousand years ago, for Theophrastus lived and brewed 
nearly four hundred years before the Christian era. 
The art of making wine, beer and other fermented 
liquors possesses such an old history, until a very few 
years ago no one knew the reason, the true secret, of 
their formation, indeed the little knowledge of the sub- 
ject then existing was purely the result of empirical 
observation, the facts, the conditions of success were 
known, but not the reasons. This is neither astonish- 
ing nor unexpected when we consider that the micro- 
scope had to be invented and perfected before definite 
and positive information regarding the phenomena of 
fermentation and putrefaction could be obtained. 



The earliest records of man's efforts to overcome the 
ravages of time and the effects of decay are to be found 
in the history of Egypt. Among the Egyptians these 
efforts took the form chiefly, of embalming the dead, 
which with them was a religious duty. The process de- 
mands a certain amount of knowledge regarding the 
preservative qualities of the various gums, aromatics 
and spices. After the decease of a person the first step 
toward embalming him was the removal of the brain 
and abdominal viscera; the rudimentary knowledge of 
anatomy possessed at this time was evidenced by the 
crude means of removal of these objectionable viscera. 
After this was accomplished the body was thoroughly 
washed and cleaned, aromatics and spices being lavish- 
ly used; then for seventy days was the body subjected 
to the action of a solution of salt when it was removed, 
and after being covered with gum or bitumen, wrapped 
or swathed in cloths in which various gums and spices 
were liberally enfolded. The body, in a suitable re- 
ceptacle, was then placed in the tomb to await mi- 
changed the summons to the Elysian fields of Aahlu. 
Here we have, crude as it is, one of the first systemati- 
cally recorded attempts at the exclusion of what was 
dimly thought to be the cause of decay, what is modern 
asepsis but a more elaborate, finished and successful 
attempt to secure the same results? 

We are more or less familiar with the skill displayed 
by the Chinese in the manufacture of gunpowder and 
silk, we have read of the wonderful records of astrolo- 
gical science in which the^ancient Assyrians sufficiently 



10 

attest their knowledge hundreds of years before the 
time of Christ; we stand amazed at the marvelous civili- 
zation of the ancient Egyptians with their comprehen- 
sive schemes of irrigation and agriculture and their ac- 
complishments in the arts and manufactures, producing 
fabrications which to this day are only excelled by 
nature herself. We are also familiar with those master- 
pieces of engineering ingenuity, hoary with age, and 
offering an archetype which none have since followed 
and the processes of whose construction none have been 
able to fully explain. These wonderful examples of 
skill, genius and ability substantiate, beyond perjAdven- 
ture, the fact that these nations had attained an en- 
viable degree of civilization and a high degree of in- 
tellectual development. With a proper understanding 
of the powers, aptitudes and possibilities of the ancient 
Egyptians before us, it seems more than incongruous 
that in their history the medical art was not permitted 
a commensurate enlightenment and erudition or that a 
degree of perfection was not attained in keeping with 
their progress in the several phases of their marvelous 
civilization. The art of embalming presents such re- 
markable results that we are constrained to place it 
among the greatest of the achievements of this wonder- 
ful people. In medicine and the collateral branches of 
science the ancient Egyptians showed as great aptitude 
and as much natural competency as in other matters; 
but the medical art was shackled by mystic practices 
and amalgamated to irrational forms of worship by 
the governing priestly classes. They were ever ready 



11 

to construe independence of thought and action as a 
threatened encroachment upon their own arrogated pre- 
rogatives or powers; their action and power rendered 
any attempt at weakening or prejudice of their investi- 
tures impossible. 

Among the Greeks we find some inklings of the truth 
as early as the middle of the fifth century before Christ 
and at that time by Empedocles, who had vague sus- 
picions of the existence of contagia and miasma in the 
atmosphere. Agrigentum had suffered a pestilential 
plague for several seasons when Empedocles noticed 
that it only originated when the sirocco prevailed and 
this blew from the south-east where it came through a 
narrow gorge; Empedocles walled up this gorge and 
Agrigentum suffered no more, 

Among the Jews we find, from the book of Leviticus, 
a primitive appreciation of the nature of some diseases; 
contagion was dimly understood and also the purifying 
effects of fire, but no reason for this was known. It is 
probable that the Hebrews, during the period of their 
bondage in Egypt, learned many things from their task- 
masters. Moses was educated at the court of Pharaoh 
and was deeply versed in the so called mystic lore of 
the period. The Jewish custom of circumcision, at 
least, must give us some feeling of respect for the 
methods of prophylaxis then prevailing, no matter how 
crude. 

We discover, however, among the Jews the same 
tendency displayed by the Egyptians, that is the re- 
striction of medicine to the priestly class, or Levites — 



12 

they took entire charge of medical affairs and associated 
them with their priestly functions. Their arrogance in 
such matters and their intolerance of all advancement 
which did not come through them is shown by the fact 
that in Salomon's time a work appeared, said to have 
been written by the sovereign himself; this work pro- 
fessed to teach how to treat disease by means of natu- 
ral methods. It was seized and destroyed by the high- 
priest Ezechias, because he thought that it would 
damage the interests of the priests and trench upon the 
prerogatives of the Levite order. 

This brings us down to the Christian era. 



II — History. 



From the Christian Era to the Beginning of 
THE Eighteenth Century. 



To quote the words of Dr. Pepper, in his presidential 
address to the Pan-American Medical Congress so re- 
cently convened at Washington, D. C: "Modern medi- 
cine has made more progress in the past twenty years 
than in the whole of the twenty centuries preceding 
them!" Hence we can expect no remarkable strides in 
the history of antisepsis in the earlier days—nay, even 
centuries — of even civilization itself. Indeed, positive 



13 

advancement would be impossible without the invalua- 
ble aid of the microscope, upon whose precision and 
certainty all modern progress in such direction is based. 

In the seventh century after the inauguration of the 
Christian era Paul d'Egineta lived and flourished. He 
condemned all measures used by physicians which tend- 
ed to hinder the action of Nature. He also declared 
that we must attribute to Nature herself the successive 
changes presented by wounds in the process of repair. 
This is a distinct advance when compared with the pre- 
vious opinions that a physician possessed and could ex- 
ercise a modified form of creative power in the treat- 
ment of wounds and traumatisms. 

Medicine, as was all learning, was plunged into the 
utter darkness of the ignorance and superstition of the 
so-called Dark Ages, only to revive in the Renaissance. 
Consequently it was nearly seven hundred years before 
even a faint glimmer of light pierced the Cimmerian 
darkness. The thirteenth century witnessed the birth 
of Rogerius, of Lanfranc and of Bruno, each one of 
whom bears an important relation to the development 
of those ideas which have culminated in modern anti- 
sepsis and asepsis. Rogerius vigorously protested 
against the use of any dressing which would antagonize 
in any way the natural operations of repair; he used 
only wine and honey, as local applications. Bruno in- 
stituted the practice of closing all incised wounds at 
once; wounds with loss of substance he caused to sup- 
purate, unless the nerves were in]\xved—i7i which case he 
was afraid that putrefaction might cause spasm! Here 



14 

we have a dim but certain appreciation of the repara- 
tive influence of the process of granulation, but, still 
more wonderful, a most accurate hint at the etiology 
of tetanud as elucidated by the science of today. 

During the next two centuries, the fourteenth and the 
fifteenth, the obsolete methods of practice were almost 
wholly continued; in fact, this period was marked by 
little or no advancement of any value or practical im- 
portance. 

De Yigo, in the fifteenth century, first enunciated his 
false and pernicious doctrine as lo the poisonous nature 
of gunshot wounds. Noticing the frequent infection of 
open and exposed wounds, he ascribed the effects ob- 
served to the presence of air and declared that access 
of air to the wound was, per se, highly objectionable. 
He made use of various powders as dressings, some of 
which were undoubtedly antiseptic in their nature, — 
not that he knew of the presence and existence of such 
germs as cause putrefaction, or the germicidal virtues 
of such agents as he used, but that empiricism, experi- 
ence, had taught him that benefit followed their appli- 
cation. 

In 1542, Michel Ange Blondus discarded all of the 
surgical dressings in use at that time and advocated the 
use of water for such purposes. After arresting hemor- 
rhage and removing foreign bodies he applied dressings 
which were soaked in water. 

From this period begins the real history of the begin- 
nings of modern treatment. The two most influential 
persons in laying the foundation of such methods were 



15 

Paracelsus and Pare. Phillipus Aureolus Theophrastus 
Paracelsus Bombastus was born at Einsiedeln, near 
Zurich, the year following the discovery of America — 
in 1493. He spent the early part of his life as a teacher 
of surgery at Basle. In the treatment of wounds be 
aimed solely at aiding^ and not combating, Nature. He 
strenuously insisted that Nature alone was competent 
for the task of repairing wounds, that non interference 
was the best policy. He believed in the existence of a 
juice in the body which kept the tissues in health and 
in proper repair when injured. In his opinion the office 
of the surgeon was to prevent any alteration in this 
liquid, which might result from contact with the air or 
other accident. He thought that Nature was usually 
sufficient for this, as was to be seen in the wounds of 
the lower animals, — the essential thing, he declared, was 
non-interference with Nature. His use of medicaments 
was only for the preservation of this juice and the pre- 
vention of its corruption or putrefaction. It is known 
that he made use of silver wire sutures and bathed or 
injected wounds with a solution of Plumbic acetate 
(Liquor Saturni). 

Ambroise Pare (1509-1584) adopted these views. He 
mentioned a number of topical applications; his great 
aim was to keep the part atGrest. Jeannel, in his work 
"Z>6 V Infection PurulentCy^ quotes passages from Pare 
which show that he attributed the fever which accom- 
panies wounds to a putrefaction of pus. He was thor- 
oughly impressed with the fact that the office of the 
physician was to assist Nature, for he says: "Or ceste 



16 

premiere et generale indication est parfaite par nature 
comme le principal agent, et par le chirurgien comme 
ministre de nature; et si nature n' est forte, le chirur- 
gien ne pourra venir a sa fin pretendue," Moreover, he 
looked upon ^ure air as beneficial to a wound and to the 
patient; but the air of sick rooms and camps he declared 
to be loaded with miasms and therefore very dangerous, 
— it is the miasms in the air rather than the air itself 
which prove dangerous, he concluded. This was a re- 
markably accurate, though crude, statement of the basis 
of antisepsis and modern antiseptic treatment three hun- 
dred years before its birth! Thanks to the writings, 
teachings and influence of these two men, old ideas be- 
gan to give way to the newer and truer view that Nature 
is the only healing power and that all that human skill 
and knowledge can do is to remove anything which in- 
terferes with the natural operations of repair. Pare 
looked especially to the constitution, strengthening it 
and removing local disturbing causes in accordance with 
the time-honored teaching of ^^Tolle causam?'^ 

Jean Andre Delacroix (15Y3) was one of the most 
successful surgeons of his time; he adopted, to a certain 
extent, the views just related in regard to the powers of 
Nature and the office of the physician. He used anti- 
septic substances largely, indeed he strongly recom- 
mends such mild antiseptics as the ethereal oils and 
alcoholic substances. After arresting hemorrhage and 
removing foreign bodies, it was his custom to wash a 
wound with a detergent liquid and then apply plasters 
composed chiefly of pitch and oil of turpentine. The 



17 

results which he obtained by his methods were excep- 
tionally good, 

Francois Arcaeus (1574) simplitied exceedingly the 
existing surgical methods, indeed his was the simplest 
of methods; it is remarkable for its close approach and 
likeness to the modern procedure. After arresting 
hemorrhage and removing foreign bodies he washed 
the wound with alcohol or wine and myrrh and then 
secured coaptation by meanis of sutures — leaving an 
opening^ if necessary^ which loas kept patulous hy means 
of a piece of lint. He then applied a balsamic prepara- 
tion. Here we have the tirst practical and successful 
attempt at systematic drainage of wounds. The meth- 
ods of Arcaeus gave remarkable results — indeed, it is 
really a fair antiseptic method and is not far removed, 
in its general principles at least, from our modern idea 
of an aseptic one. 

Wurtz (1596) lived in terror of what he believed to 
be the contaminating influence of air upon wounds. So 
far did he carry his fear of his bugbear that he kept the 
door of the sick-room tightly fastened while he changed 
the dressings as rapidly as possible. 

Near the end of the sixteenth century Vicary made 
use of balsams and balsamic preparations for dressings 
and with excellent results. 

The greatest and chiefest advances made during the 
sixteenth century were the reassertion, in no uncertain 
tones, of the part played by Nature as the principal agent 
and healing power in the process of repair, the relin- 
quishment of all idea as to the power of the physician 



18 

in making flesh or tissue and the abandonment of the 
idea of "feeding" wounds. We note, during this 
period, the first recommendation to apply antiseptic 
substances to wounds; this was the result of the obser- 
vation of the success attendent upon the use of such 
agents, as in the case of the balsam of Arcaeus which 
acquired great fame. It was during this century that 
the first declaration of the infectious nature of air, or its 
constituent impurities or contaminations rather, was 
made; also the first crude and somewhat grotesque at- 
tempt to exclude air and its infectious principles from 
wounds. We observe also, at this time, the first at- 
tempt to drain wounds of the morbid products and se- 
cretions upon which pyogenic and pathogenic micro- 
organisms flourish. Such methods were, of course, 
largely the result of either chance, shrewd observation 
or empiricism for there was and could be no correct 
knowledge of the principles involved in such practices 
or in the attainment of such results — in other words, 
lacking scientific precision and devoid of scientific arma- 
mentaria, systematic observation and study was almost 
an utter impossibility, hence the only recourse was em- 
piricism and observation. Paracelsus, though correctly 
named Bombastus, rendered an incalculable service to 
medicine when he so scathingly denounced slavish ad- 
herence to old and obsolete methods of practice; he was 
among the first to assail, with dauntless intrepidity, the 
very teachings of Aristotle and others whose opinions 
and doctrines had prevailed for centuries — he was a 
revolutionist of a most pronounced type. Thanks to 



19 

him, many obsolete procedures were sent hurtling into 
the abyss of chaos and oblivion. 

Magatus (1616) is among the first whom we note in 
the dawn of the seventeenth century. He thoroughly 
appreciated and insisted upon the importance of rest in 
the treatment of wounds. He revived the doctrine of 
the evil effects of air upon wounds; he claimed that the 
air was full of miasms which affect the parts with which 
they come in contact. This was indisputably proven, 
he thought, by the fact that a punctured egg began to 
decay immediately. Hence, acting in accordance with 
his beliefs, he seldom changed dressings for fear of the 
contact of air and consequent infection of the wound. 

The discovery of the actual existence of micro-organ- 
isms may be said to have been made by Anthony Van 
Leeuwenhoek. In 1675 he observed, by the aid of a 
single lens, multitudes of animalculaB swarming in a 
drop of stagnant and putrid water which he had, by 
chance, placed beneath his*glass. This is the very first 
recorded observation of such organisms and has passed 
into history as the incident of the discovery of the mi- 
crobes. This same astute old scientist, in 1683. discov- 
ered small, motile bodies in the mucus of the mouth 
and gave clear and minute descriptions of their appear- 
ance and movements; he also discovered the existence 
of micro-organisms in the feces and in the tartar of the 
teeth. From his drawings and remarkably clear de- 
scriptions of the bodies there is very little reason to 
doubt that he saw what are known to modern bacteri- 
ology as bacteria and vibrions. While Leeuwenhoek 



20 

discovered such bodies he had no idea of the important 
role which the result of his discovery was to play in the 
practice of medicine in years to come. Nevertheless 
his discovery is a most important one, laying, as it 
does, the first substantial foundation for the subsequent 
discoveries upon which the whole of the modern prac- 
tice is founded. 

Robert Boyle, in 1676, made a most startling decl 
ration in his "Essay on the Pathological Part of the 
Physik," it was as follows: 

"He that thoroughly understands the nature of fer- 
ments and fermentation shall probably be much better 
able than he that ignores them, to give a fair account of 
divers diseases (as well fevers as others), which will per- 
haps be never properly understood without an insight in- 
to the doctrine of fermentations?^ (The italics are mine). 
When we consider that Leeuwenhoek had made his dis- 
covery only a year previously and that no ideas of the 
connection between microoi^anisms, fermentation and 
disease had, as yet, been promulgated, this statement, 
so plainly and so unmistakably couched, seems to bor- 
der upon the marvelously prophetic. Certainly in the 
domain of surgery, as well as that of general medicine, 
Boyle's surmise has been more than realized. 

Richard Wiseman (1692) was a man of remarkably 
good views and practices. In the coaptation of wounds 
he advised the use of no violence. He declared that the 
process of agglutination is the work of Nature alone; 
that, since the blood is the natural glue, the physician 
must take care that it is good and support the patient's 



21 

strength. He made use of turpentine and cooling and 
astringent lotions as dressings and sprinkled powders 
over large wounds. 

Sir John Colbatch (1698) made use of an aqueous 
solution of sulphurous acid; he recommended it as fol- 
lows: 

"It is an excellent medicine, being taken by way of 
prevention in infectious seasons; and I think if any 
medicine deserves that name this doth deserve to be 
called the true prophylacticon." 

His Novum Lumen Chirurgicumy which appeared in 
1'704, was a most remarkable treatise — a new surgical 
light, indeed! He described a medicament which he 
used which gave results comparable only to the results 
attained by the true aseptic methods of the present 
time. Unfortunately he kept its composition a secret 
and concealed his method also, hence it has become lost 
to the world although the reliability and accuracy of 
the results attained thereby are sufficiently attested to 
insure their truth; furthermore, the graphic description 
which he gives of the progress of his cases could not 
have been imagined, at that time, by any one who had 
not seen and was not practically familiar with the facts. 
He describes with peculiar accuracy what we now call a 
typical aseptic course; nor can there be any doubt that 
he was familiar with the fact of the vascularization of 
the blood clot and its replacement by new tissue, pre- 
cisely as has been described by Lister, the modern 
*^Father of Antiseptic Surgery." In his preface he as- 
serts that the methods of former times, and indeed of 



22 

his very own, were far from the best. He furthermore 
says, somewhat significantly, that: "The corruption of 
the nutritive juice cannot be performed without a sort 
of fermentation and it is the fermentation particularly 
that, fretting the fibres, causes inflammation in wounds 
and by entering into the blood and dividing its texture 
causes symptomatic fevers which frequently prove so 
fatal.'' What marvel of a man have we here! What a 
pity that he saw fit to retain a secret which would have 
caused his name to ring with praise through every age! 
The medical profession completely ignored the teach- 
ings and results of Colbatch and indeed, ultimately, al- 
most forgot them entirely; so that his brilliant mind and 
his brilliant work made absolutely no impression upon 
the history of medical progress. 

He also referred to the fact that in all wounds the 
patient was put on a low diet and, more often than not, 
blood was taken from him in large quantities, thereby 
greatly weakening him; he protested vigorously against 
such a policy, but to no avail. 

Neudorfer thinks that Colbatch's powder must have 
been ammonic salicylate, on account of the smell of 
roses to which the latter refers. Its action is thus de- 
scribed by its user: "In all incised wounds, where my 
medixjines have been soon enough used and no other ap- 
plication preceded, they are perfectly cured in a few 
days without suppuration.'^^ He also observed the pro- 
cess of granulation and the organization and transfor- 
mation of the blood clot into new tissue. 

In the seventeenth century but little real progress 




s 

H 
H 

W 

W 

EH 

o 



Ph 



23 

was made by the medical profession. The attempt at 
exclusion of air from wounds and the insistance upon 
mechanical rest, which in themselves were not new 
ideas, were the chief points promulgated. True, we 
note the discovery of micro-organisms by Leeuwenhoek, 
the remarkable declaration of Robert Boyle and the 
highly creditable achievements of Sir John Colbatch, 
all of which transpired in this century, but these were 
brilliant individual exceptions — not one made a lasting 
impression upon the medical progress of the time, in- 
deed they were hardly appreciated for more than a cen- 
tury. With these exceptions, the history of the seven- 
teenth century is almost a step in retrogression when 
compared with the sixteenth century. 

This brings us down to the eighteenth century. 



Ill — History. 



From the Beginning op the Eighteenth to the 
First Six Decades of the Present Century. 



The eighteenth century is somewhat remarkable for 
its dearth of illustrious names in the history of anti- 
sepsis, for very little true progress has been made at all 
in that period. 

Augustin Belloste (1700) reiterated the teachings of 



24 ^ 

Magatus, to whom he allied himself. He insisted more 
particularly upon coaptation — even of bony structures, 

Parmanus Cl'^06) made use of a lotion of his own by 
virtue of which he claimed to be able to "resist putre- 
faction, prevent ill accidents and take away the pain 
and inflammation of a wound," This he used in the 
treatment of all wounds, keeping the dressings moist- 
ened with it constantly and changing them every two 
or three days. 

Anel (1706) in the same year published his method 
of evacuating abscesses by a process of aspiration 
which left no open wound — similar in fact to the 
method of removing blood from the chest which was 
originated by Delacroix in 1573, 

Boerhaave (1720), so well known in the history of 
the development of the science of chemistry, claimed 
that the absorption of pus caused internal abscesses; 
this was a step in the direction of the somewhat more 
modern pyemia. 

Col de Villars (1741) insisted that dressings should 
be frequently changed, in order to prevent putrefaction. 

Heister (1753) made . extensive use of balsams in 
order to remove anything that might hinder the natural 
processes, especially suppuration — which he classed as 
such. In order to remove the products of suppuration, 
which he correctly deemed ujiwholesome, he made use 
of drainage by means of openings and counter-openings. 

Bilguer (1764) was accustomed to fill all of the re- 
cesses of a wound with an antiseptic substance and to 
lay over the wound a piece of lint which had been 



:^o 



dipped in an antiseptic solution. He decried the almost 
universal custom of promiscuous amputation which he 
inveighed mercilessly. Indeed, he claimed that ampu- 
tation might be almost totally dispensed with and gave 
both facts and figures to uphold his teachings. 

Dr. Pringle, in his Observations on Diseases of the 
Army, published in London in 1765, called the at- 
tention of the medical profession to the fact that cin- 
chona bark, whether used in decoction or in powder, 
possessed the power of preventing putrefaction of flesh 
for a time. The peculiar antiseptic^ qualities of cin- 
chona and quinia have been more recently investigated 
and confirmed by Mayer, Pavisi, Hallier, Herbst, Polli, 
Binz and Bochefontaine. 

Percival Pott (1768) sealed wounds very effectually 
in cases of compound fracture; but, at the same time, 
he insisted upon the maiDtenance of proper drainage by 
means of openings and counter openings. 

The valuable preservative effects of sulphurous acid, 
its gaseous anhydride and its salts were known as early 
as the year l77l. 

Muller (1773) made an attempt to classify the minute 
organisms which had been observed by others. Although 
Leeuwenhoeck first observed micro-organisms in 1675 
it was nearly a century before an attempt was made to 
define the character of these organisms and to classify 
them The knowledge of the subject possessed at this 
time was of a most rudimentary and elementary nature, 
hence Muller's work possesses naught of interest save 



26 

the fact that his was the first definite attempt at sys- 
tematic classification. 

BeDJamin Bell (1784) made use of drainage in 
wounds, using leaden tubes for that purpose. He ad- 
vised the employment of simple wound dressing, and 
also that all punctures of the skin, etc., should be val- 
vular in character so as to prevent free access of air and 
objectionable matters to the wound. 

In 1785, Lombard and Percy learned that a certain 
Alsatian physician possessed an infallible remedy for 
wounds. This infallible remedy proved to be pure 
river water which was used with magic phrases and in- 
cantations. Upon trial they found the water to possess 
the same efficacious virtues even when used without the 
magic phrases. 

John Hunter (1792) taught that air was harmless as 
far as its influence upon wounds was concerned and that 
infl^ammation was due to an inherent tendency of 
wounds. He instituted researches on the healing of 
wounds beneath a scab — these researches were of much 
importance and interest. He also maintained that the 
process of healing must be left to Nature. 

August Gottlieb Richter (1799) made use of openings 
and counter-openings for aid in the removal of pus. 

And thus the century closes, without one discovery 
of importance, devoid even of one plausible and im- 
portant theory. Down to the time of Priestley's dis- 
covery of oxygen, August 1, 1774, the deleterious 
effects of air, with few exceptions, were supposed to 
be due largely to temperature. Pare had declared it as 



27 

his belief that such effects were due to miasms; others 
looked upon the putrefaction of the discharges from the 
wound as the source of the evil and, as in the cases of 
Colbatch and Bilguer, succeeded sometimes in prevent- 
ing such putrefaction. Mayow, in the latter part of the 
seventeenth century, declared that all fermentation was 
due to the "nitro aerial spirit" of the air — from his ac 
curate description this "nitroaerial spirit" was nothing 
more nor less than our modern oxygen. Benjamin Bell 
however, in the latter part of the eighteenth century, 
discarded all of these views, holding that the trouble 
was caused chiefly by "fixed air" (carbon di oxid). 
This view of Bell's, erroneous as it was, was developed 
and accepted by many, down until the very days of 
modern antiseptic surgery. 

The first name of any interest to attract our attention 
in the inception of the present century is that of Von 
Kern. He (1809) made the claim that the only essen- 
tials in the treatment of wounds were cold water for the 
arrest of hemorrhage, warm water for dressing, some 
small pieces of lint, absolute mechanical rest and artifi- 
cial heat. So popular did these views become that they 
were adopted by Von Walther of Bonn, Fritze of 
Prague and by Lister himself — indeed these methods 
of wound treatment continued in vogue in England 
until about thirty years ago. 

The antiseptic and preservative properties of coal-tar 
were recognized by Chaumette (1815), by Guibourt 
(1833), by Sivet (1836), and by Bayard (1846). The 
famous panacea, tar-water, recommended so highly and 



28 

extravagantly by tbe celebrated Bishop Berkley has 
become a matter of history, although as far as practical 
use is concerned it sleeps the sleep of eternal oblivion. 

Constant and intermittent irrigations of wounds was 
recommended by many throughout the present century 
but has been associated with the name of Langenbeck 
since the year 1839. 

However, before the processes of fermentation and 
putrefaction could be thoroughly understood the micro- 
scope had to be invented and brought to some degree of 
perfection. Leeuwenhoeck, in 1680, found yeast to be 
a mass of globules bat he had not the slightest con- 
ception of the fact that they were living organisms; 
this fact it remained for Caignard de la Tour to eluci- 
date in 1836, which was the first step toward the estab- 
lishment of the rudimentary tenets of what was to de- 
velop into the germ theory of disease. In the year 
1836 Caignard de la Tour determined that the yeast 
plant (Torula cerevisise or Saccharomyces cerevisise) 
was a microscopic vegetable cell which, through in- 
crease in the number of cells, broke up sugar into 
alcohol and carbon di oxid. With the death of the 
yeast cell or when, through any cause, it could increase 
no longer fermentation ceased. 

In this same year Schulze proved that putrefaction 
was not due to oxygen. Gay Lussac had held that 
putrefaction did not take place in hermetically sealed 
vessels because the oxygen was excluded therefrom. 
This objection Franz Schulze met by admitting air 
which had been drawn through strong sulphuric acid to 



29 

boiled putrescible liquids; in which case putrefaction 
did not supervene, thus confuting Gay-Lusfeac's doctrine 
utterly. This was confirmed by Schwann (1839), Ure 
(1840) and Helmholtz (1843). 

In the same year in which Caignard de la Tour made 
his discovery and Schulze confuted GayLussac's doc- 
trine, Donne (1836) noticed micro-organisms in pus and 
also in chancrous pus — the latter different from the 
former and causing its virulence. In the following year 
Beauperthuis and Adet de Roseville noticed the latter 
organisms and declared them to be the cause of putre- 
faction, in the next year (1838). 

In 1837 Schwann of Berlin published the results of a 
remarkable series of experiments in the phenomena of 
putrefaction, proving them due to organisms and not to 
the oxygen of the air. His experiments proved that 
meat and other albumenoids became decomposed by the 
germs resident in the atmosphere; he clearly estab- 
lished the connection between putrefaction and micro- 
scopic life, but thirty years elapsed before Lister ex- 
tended to wounds and living flesh the results of the 
researches of Schwann upon dead flesh and animal in- 
fusions. Prior to Lister himself the possibility of some 
such extension of the principles had occurred to other 
minds, such as Beauperthuis and Adet de Roseville. 
Penetrative, thoughtful minds had appreciated the fact 
that the germs which could cause putrefaction of meat 
and dead flesh might also act with fatal effect upon the 
living flesh in the hospital or sick room. Although the 
views of Caignard de la Tour, Schwann and Schulze 



30 

were tested and confirmed by many learned investi- 
gators, such as Ure and Helmholtz, they did not receive 
the attention due them, they obtained no general recog- 
nition but remained the property of a few skilled ex- 
perimenters. It was admitted that the fermentation of 
sugar was due to the torulaB but it was not admitted 
that putrefaction was due to precisely analogous agen- 
cies, yet the two processes present more than merely 
striking parallels. 

In 1841 Dujardin, who had devoted considerable at- 
tention to the subject, classed bacteria among the infu- 
soria. In 1843 Helmholtz confirmed the doctrines of 
Schwann and Schulze. 

In 1849 Pollender declared that he had observed 
organisms in the blood of animals that had died of 
splenic fever (anthrax). 

In 1850 two distinguished French observers, M. 
Davainne and M. Rayer, noticed small organisms like 
transparent rods in the blood of animals dying with 
splenic fever. They, at that time, however, attached 
no especial importance to the discovery of this fact. 
Eleven years later Pasteur published his masterly 
memoir on the fermentation of butyric acid and de- 
scribed the organism which provoked and caused such 
fermentation; after reading this memoir Davainne came 
to the conclusion that splenic fever might also be 
caused by a fermentation or putrefaction set up and 
provoked by the germs which he and Rayer had ob- 
served in 1850. This idea has been placed beyond the 
pale of a peradventure by subsequent researches. 



31 

Up to the year 1850 the existence of micro-organisms 
had been confirmed by the investigations of many 
scientists, but the spores or germinal elements of the 
microbean cells were first observed by Perty in 1852 
and by Robin in 1853. 

In the year 1854 a very simple but important dis- 
covery was made by Schroeder aud Von Dusch; this 
was the discovery of the fact that a plug of cotton wool 
or raw cotton placed in the mouth of test tubes would 
preserve even nutrient media contained therein from 
infection and consequent putrefaction. Simple as this 
discovery was, it has been of great service in practical 
and laboratory work in bacteriology. 

In 1856 Panum demonstrated that inflammation of 
the intestinal tract of animals poisoned by decomposing 
matter was due to a chemical substance which was not 
destroyed by heat. This was probably one of the first 
observations of any value made as to the detrimental 
action of the products of germ excrementition or elabo- 
ration. Somewhat later Sohmiedeberg and Bergmann 
isolated from fecal matter a crystalline substace which 
they called sepsin. They determined that when this 
substance was introduced into bodies it caused symp- 
toms which were peculiarly analogous to those of the 
condition known as septicemia. As interesting and im- 
portant as were these observations of Panum, Sohmiede- 
berg and Bergmann they were practically devoid of any 
influence whatever upon current medical practice. 

In the period from 1857 to 1861 Polli of Milan made 
extensive observations upon the power of sulphurous 



32 

acid and the sulphites in arresting fermentative and 
putrefactive processes. As a result of his numerous 
experiments and observations he initiated and formu- 
lated a plan for their use and administration in certain 
diseases which he thought caused by such conditions, 
that is, in zymotic diseases. In this same period 
Calvert had demonstrated that carbolic or phenic acid, 
which was always present in coal tar, was a powerful 
disinfectant and that it had been used in Manchester in 
1857 for th*^ preservation of dead bodies. 

In 1859 M.Davainne attempted a new classification of 
micro-organisms, placing them in the vegetable kingdom. 

In 1860 Pasteur demonstrated that a temperature of 
110^-112^C, (the boiling point of water being lOO^C) 
was sufficient to completely sterilize. In the next year 
(1861) he published his memoir upon butyric fermenta- 
tion and the organism provoking it — it was this essay 
that convinced Davainne (1863) that the organisms 
which, in 1850, he and Rayer had observed in the 
blood of animals infected with splenic fever (anthrax) 
were the cause of the disease and he so announced his 
belief. 

Since the time of the discovery of the yeast plant by 
Caignard de la Tour the question of the origin of such 
organisms had been one which had given rise to conti- 
nuous discussion and investigation on the part of a few. 
In 1862 Pasteur published a memoir in the Annales de 
Ghimie which marked the inauguration of a new epoch; 
to the continuation of the investigations therein first set 
forth he has devoted the whole of the remainder of his 



33 



life. His solutions of the secrets of vinous, ace- 
tic and butyric fermentations unlocked the secrets of 
putrefactive fermentation — a discovery whose inesti- 
mable value we can only duly appreciate when we con- 
sider the woes which these wafted particles of micro- 
scopic life have caused in ages both historic and pre- 
historic. Compared with this record the mortalities of 
the world's battlefields pale into insignificance itself. 

In this same year (1862) Dr. William Budd drew up 
a series of suggestions for the investigation of epidemic 
and epizootic diseases. To this he adds: "What we 
most want to know in regard to this whole group of 
diseases is where, and how, the specific poisons which 
cause them breed and multiply ."^^ There cannot be the 
slightest doubt, after perusal of this passage, that Dr. 
Budd had what might be considered — even at this day 
— a good modern conception of the subject, for his 
ominous words are in no sense ambiguous. 

In the next year (1863) Lemaire, stimulated by Cal- 
vert's investigations into the antiseptic properties of 
carbolic acid and by numerous similar facts which had 
been laid before the Committee of the French Academy 
studied the subject diligently. The results he embodied 
in his memoir "De I'acide phenique," published in 1863. 
In this essay he recognized the germ theory of disease 
as the actual basis of antiseptic surgery and was one of 
the first to recognize its extensive use in the treatment 
of wounds. He extended the already existing belief in 
the preservative properties of carbolic acid and coal tar 
— for the Egyptians themselves used pyroligneous acid, 



34 

creosote and analogous compounds for these very pur- 
poses in the preparation of their mummies. 

These, the first six decades of the present century, 
mark an important era in the development and growth 
of the belief and practice which was to pervade the 
latter decades of the century, much to its enlightenment 
and much to the value of the science of medicine whose 
prophylactic functions at least are thereby greatly 
widened. Among the many men of note in thp period, 
among even so many worthy investigators Pasteur, as 
yet, stands head and shoulder above them all. Although 
the views of de la Tour, of Schwann and of Schulze 
were confirmed by several trustworthy investigators yet 
they made no marked impression, remaining the 
property solely of a few skilled investigators. It was 
Pasteur who first conclusively convinced the scientific 
world. Because of his precision and accuracy his ex- 
periments remain, even to day, unimpugned and above 
reproach. Pasteur's observations first resulted in facts 
of value—especially from a surgical and medical stand 
point. The practical application has saved the vine- 
yards of France from the dreaded depredations of phyl- 
loxera and has prevented and eradicated many parasitic 
diseases of both plant and animal life. But most of all 
they enabled Lister to formulate his immortal system 
of antiseptic surgery which has saved many useful 
lives. He first claimed that the processes of fermenta- 
tion, decomposition, suppuration and the occurrence of 
contagious diseases were all due to the presence of 
microorganisms— which principle he called contagium 



35 

animatum. He also claimed that the processes which 
were due to the access, proliferation and multiplication 
of germs might be prevented by securing non-access of 
such germs. 

He was not the first nor was he the only one to ob- 
serve the facts embodied in his contagiurn animatum or 
infection by an organism, for the belief in its rudiment- 
ary state can be traced back to the year 1700 when the 
question was warmly discussed under the subject of 
spontaneous generation. Nevertheless his work, his in- 
vestigations, his discoveries prepared and paved the 
way for the deductions of Lister who himself acknowl- 
edges his indebtedness to Pasteur and his researches. 

In ]864 Spencer Wells, before the British Medical 
Association, pointed out the fact that the recent experi- 
ments of Pasteur had "all a very important bearing 
upon the development of purulent inflammation and the 
whole class of diseases most fatal in hospitals and other 
overcrowded places." He said further: ''Their in- 
fluence (germs) on the propagation of epidemic and 
contagious diseases has yet to be made out." Strange 
to say, though he recognized and admitted the ejffect and 
power of the organisms, he introduced no systematic 
method of combating them or of eliminating their in- 
jurious effects and yet in his own particular and peculiar 
sphere of practice has antiseptic surgery been most con- 
spicuous and complete in its triumph. 

As we observe, the time is now ripe, medical theory 
and practice is ready to receive the truths of a new and 
doughty champion whose work prior to this time 



36 

would doubtless have fallen upon sterile and unfruitful 
soil. The time has come when the efforts are to be 
crystallized, or the blossom to merge into the tangible 
fruit. Only at this particular time would his advent 
have been successful and at the precise moment of the 
need of his trenchant blade Joseph Lister steps into the 
scientific arena. 



IV. — History. 



From the Advent of LivSter to the Present 
Time. 

In the fullness of time appeared the man for whose 
coming the fates seemed to have conspired together. 
Neither too late nor too early did he appear, but when 
scientific discoveries had prepared the way and had made 
the minds of men ready to receive and profit by the ob- 
servations which he had madeand the conclusions which 
he had drawn from his observations. That the seed fell 
on good soil and flourished the splendid achievements of 
modern medicine, surgery and obstetrics fully attest. 
What medical science would have been without these 
grand generalizations and their subsequent results is 
shown by the condition in the era immediately preced- 
ing their enunciation and demonstration. To-day the 




HOSPITAL IX THE FRENCH THEATRE. 



37 

germ theory of disease is the very foundation upon 
which the magnificent superstructure of modern medi- 
cine rests— ay, we might almost say that it is at once 
the foundation and the structure. 

In the London Lancet of July 27^ 1867, appeared an 
article by Dr, Joseph Lister entitled "A new method of 
treatment of Hernia in the presence of Atmospheric 
Air." This was the first step taken by him in the direc- 
tion which was to ultimately yield him so many honors, 
so many laurels, so many brilliant results in the saving 
of human life in its battle with disease. Here was the 
germ of the acorn which was to spring into such a 
mighty oak, bearing healing in its leaves. In September 
of the same year another article by Lister appeared in 
the Lancet entitled "On the antiseptic principle in the 
practice of Surgery." This marks the date of the birth 
of the true antiseptic era — indeed it is the first use of 
the term antiseptic, being used in the sense of opposed 
to putrefaction. Lister's views in regard to the essen- 
tials of antiseptic wound treatment at this stage in the 
development of the practice may best be imparted in 
his own words: 

"Decompositions in a wound and affections of wounds 
due to decomposition, are intimately connected with 
micro-organisms coming from without. 

The wound treatment and dressing should prevent the 
access of micro organisms, and, when these have entered 
notwithstanding every care, they should kill them or 
render them incapable of harm. 

The dressing and the substances used for killing the 



38 

micro-organisms should not irritate the wound at all, or, 
at best, very little." 

Lister's system of treatment consisted essentially in 
the exclusion of such micro-organisms as might possibly 
by their presence induce fermentative changes; or if, in 
spite of such precautions, such have gained access, to 
remove, or destroy them or at least render them innocu- 
ous. Such ends, he said, were to be attained by the use 
of certain germicidal substances. In this way pyemia, 
septicemia and erysipelas, once the scourges of surgical 
hospitals have, within a short period, become diseases of 
rarer occurrence than formerly. His favorite antiseptic 
was carbolic acid dissolved in various menstrua or im- 
pregnated in gauze, cotton wool or other surgical dress- 
ings. He claimed that if the treatment was thoroughly 
carried out the result would be no pain, no fever, no pus, 
no bacteria, no putrid smell, no septic infection and 
progress uninterrupted by any septic process. His claims 
in this respect seem to be almost fully borne out by the 
results achieved, for many operations are now safely 
and fearlessly performed which were formerly very for- 
midable and fraught with considerable danger; such 
were the operations upon joints, bones, the peritoneum 
and other serous membranes. Then too in many cases 
where amputation was formerly and correctly (under the 
circumstances) deemed absolutely necessary the limb 
has been saved by the use of antiseptic methods; before 
the introduction of antiseptic methods the mortality fol- 
lowing major operations was very high — in the period of 
1864-1866 statistics place it at forty-five per cent (45%). 



39 

In the period immediately foUowiogthe introduction of 
the antiseptic method (still in its infancy, still crude and 
undeveloped) the rate dropped marvelously to the low 
figure of fifteen per cent (15%) — which meant that 
thirty more lives out of every hundred were saved by 
this method that would have been sacrificed by the use 
of the methods in vogue in surgery before the introduc- 
tion of the antiseptic method. In the period of 1871- 
1877, after Lister had somewhat modified his method, 
the rate dropped to twelve per cent (12%)! This was 
one of the greatest triumphs which modern medicine 
has ever witnessed, — indeed its effect should not for a 
moment be underestimated. Volkmann, the renowned 
surgeon of Halle, was about to close his wards on ac 
count of the prevalence and virulence of pyemia and 
septicemia; as a last resort he tried the methods of Lister 
and in the next five years the total mortality did not ex- 
ceed six jyer cent (6%)! 

That surgical *'dirt" was fatal to success if not life 
itself in surgical operations had been noticed long be- 
fore Lister's time, but few know the reason why. It 
was at this point that Lister sprang full panoplied into 
the scientific arena, coming forward with a theory or a 
scientific principle rather, which rendered it all very 
plain and rational. This surgical "dirt" then was fatal 
or infectious not because it was "dirt" but because it con- 
tained, as Schwann first proved, living germs which 
were themselves the direct causes of putrefaction and 
decomposition. In the year 1837 Schwann clearly dem- 
onstrated and established the connection between putre- 



^0 

faction and microscopic life, that one followed from the 
other, that they were coincident and coexistent. But 
thirty years elapsed before Lister extended to wounds 
and living flesh the results of the researches of Schwann 
upon dead flesh and animal infusions. Prior to Lister 
himself the possibility of some such extension of prin- 
ciples had occurred to others — indeed Hueter had dis- 
tinctly said twenty-five years before "no germ, no pus." 
Lister discovered no great scientific fact, yet he more 
than any one man created antiseptic medicine. To him 
pre-eminently belongs the honor and glory of extending 
the generalization of Schwann from dead to living mat- 
ter; but by this apparently simple step he at once re- 
volutionized the whole art and practice of surgery — in- 
deed, now it became in truth a science. It was he too 
vrho first formulated a systematic method by means of 
which to fight these microscopic enemies of life and 
health. But his researches dealt with and applied to 
decomposition and putrefaction and conditions depen- 
dent upon them. It remained for Koch to further ex- 
tend the generalizations, it remained for Koch to dis- 
cover the existence of specific pathogenic germs, that 
each one of the infectious or zymotic diseases was 
caused by its own and peculiar germ. It was sufficient 
glory for Lister to have laid the foundation and he was 
magnanimous enough to acknowledge the aid which he 
had received from Pasteur in this great work (See Etudes 
sur la £iere — Pasteur, page 43) — indeed he expressly 
thanks Pasteur for having given to him the only prin- 
ciple which could have conducted the antiseptic systme 



41 



ot treatment to a successful issue. To these three— Lister, 
Pasteur and Koch — the founders of the triumphs of 
modern medicine, be all the glory. 

In the year 1870 Lister presented to the medical 
world his method of surgical dressing; this is now dis- 
carded even by himself, but the principles upon which 
it was based remain true to this day. 

In the year 1873 Obermeier announced his discovery 
of the specific germ of relapsing fever. This the dis 
Goverer named, after himself, the "Spirochete Ober- 
meieri." 

In 1876 Cohn and Koch devoted considerable time to 
an investigation of spores— the peculiar reproductive 
bodies of some forms of germ life. Until this time 
comparatively little attention had been paid to them, 
through ignorance of their importance. 

In the next year Koch announced his discovery of the 
fact that the terrible disease anthrax was due to a pecu 
lier and specific germ which he had succeeded in isolat- 
ing. In this same year Weigert introduced his method 
of staining germs in order to make them plainly visible 
in the microscopic field and thus to facilitate observa- 
tion of their habits, peculiarities, etc. 

In the year 1878 Koch, who was becoming exceeding 
ly prominent in the field of bacteriology, published his 
important work on traumatic infectious diseases. 

In the next year Hansen announced his discovery of 
the specifie bacillus of leprous tubercles. In the same 
year Neisser discovered the gonococcus, supposed to be 
the specific cause of gonorrhea. 



42 

In 1880 Laveran successfully demonstrated the rela- 
tion of the "Plasmodium malariae" to the etiology of 
malarial disease. In this same year Eberth and Koch 
made their discoveries of the specific germ which caused 
typhoid fever. Sternberg and Pasteur also made im- 
portant researches into the nature and origin of pneu- 
monia and discovered its diplococcus. But the most 
important work and discovery of the year was Koch's 
announcement of his experiments and belief in the effi- 
cacy of protective inoculations of attenuated cultures of 
germs. Thus he points a way for the medicine of the 
fnture. Indeed the important work of the past few 
years has been mainly in this direction — its legitimate 
outcome was the tuberculin of Koch, the anti-cholerine 
of Klebs, etc. 

In the next year Koch called attention to what he con 
sidered the greater potency of mercuric chloride as an 
antiseptic; this he recommended in the strength of 1:1,- 
000. In the same year he made important researches on 
the resistive powers of anthrax spores to heat. He also 
introduced the use of solid culture media and the plate 
method for pure cultures. 

In 1882 Schutz and Loffler announced their discovery 
of the bacillus of glanders and Pasteur issued his first 
communication on the subject of rabies — a field of work 
in which he has so justly become famous. But the 
greatest work of all was to come in the demonstration 
of the cause of tuberculosis. This was accomplished by 
Robert Koch. In the month of March, 1882, he read a 
paper ou the subject before the Berlin Congress; sq 



43 

complete and thorough was his work and so convincing 
were his conclusions and proofs that no one left that 
hall unconvinced that the true cause of that dread dis- 
ease which carries off more than war and famine com- 
bined had at last been discovered. This did not neces- 
sarily mean its cure, but it was a vast stride in that 
direction. And this work he achieved in the face of 
what were thought to be insurmountable obstacles. 

In the next year the British Government, recognizing 
the service which Lister had rendered humanity, 
knighted him, bestowing upon him the title of Baronet. 

In 1884 GafiEky made important researches upon the 
bacillus of typhoid fever. In this same year Nicolaier 
discovered the bacillus of tetanus, Loffler the bacillus of 
diphtheria and Koch the cholera spirillum or "comma 
bacillus." In the next half-dozen years comparatively 
little was accomplished. 

In 1890 Baumgarten made a new classification of 
micro-organisms. 

In 1892 Pfeiffer and Canon independently discovered 
the specific germ of influenza, the bacillus influenzaB. 

In 1893 Sir Joseph Lister, after twenty years of ex- 
periment and research renewed his allegiance to carbolic 
acid as the antiseptic par excellence^ He announced 
that carbolic acid is not only a more eflEicient germicide 
than corrosive sublimate (that is, mercuric chloride 
which had previously been the favorite antiseptic, des- 
pite its poisonous nature in even comparatively small 
amounts) but that it is much more efficient in cleansing 
the skin. Also that it has a powerful affinity for the 



44: 

epidermis, penetrating deeply into its substance and 
mingling with fatty matters in any proportion. Whereas 
corrosive sublimate cannot penetrate greasy substances 
in the slightest degree, hence when used it requires 
elaborate preparation of the field of operation in the 
way of scrubbing and cleansing the skin. In accordance 
with these the latest conclusions of the pioneer in the 
field of antiseptic surgery, American enterpise has met 
the emergency by putting into the surgeon's armentarium 
a new antiseptic composed of carbolic acid and boracic 
acid; this product has been very fittingly named Senn- 
ine after one who has done so much for American sur 
gery. 

As Dr. Pepper recently said in his presidential ad- 
dress to the Pan-American Medical Congress: "Every 
one now knows, or ought to know, that disease is due in 
a vast majority of instances to micro-organisms which 
live, flourish and die subject to certain and peculiar 
laws." So that it almost seems like folly in these clos- 
ing years of the nineteenth century to insist upon the 
truth of the germ theory of disease; it is a part of the 
history of the medical progress of the century and there 
are, indeed, none so blind as those who will not see. 

Research has undoubtedly established and demon- 
strated a distinct and direct relation between certain 
forms of infectious diseases and their specific micro- 
organisms. All authorities and investigators agree that, 
whether these organisms are the virtual causes or but 
concomitants, the processes and phenomena attendant 
upon their invasion, development and decay within the 



45 

tissues give rise to the elaboration of substances as 
deadly as the most toxic of drugs. These substances, 
called ptomaines, leucomaines, etc., are chiefly the re- 
sult of the processes of excrementition and elimination 
which are naturally coincident with the life history of 
the germ and unless neutralizedj destroyed or eliminated 
in some manner are as fatal to life or health as the most 
powerful of toxic agents. It is now definitely known 
that the alarming symptoms of many of the infectious 
diseases are due more to the presence of these products 
rather than to the presence of the germ per se. As in 
tetanus, the germ may be localized in its action but its 
excrementitious products, may be absorbed and carried 
through the avenues of the vessels to all parts of the 
system and thus from many points of attack completely 
overwhelm it. 

But the presence of germs is not necessarily destruc- 
tive to the life of the human organism. In health the 
pathogenic germ does not find sustenance and can not 
thrive in the normal and healthy secretions of the body 
and when such germs invade the system they are des- 
troyed by certain of the white blood corpuscles by 
means af the process of phagocytosis. But when the 
organism becomes debilitated and disordered the omni- 
present germs find sustenance in its depraved secretions 
and thrive and multiply there antil they completely 
overwhelm and destroy it. When health, the great and 
universal antiseptic, is impaired in its virtues then 
Nature must of necessity lean and depend upon Art. 



46 



V. — The Products of Vital Cellular and 
Bacterial Activity. 



The time has long past when the doctrine of the 
micro-organic origin of disease and infection was forced 
to contest its claims to recognition and acceptance. It 
stands today in the position of a demonstrated and 
generally accepted fact. Indeed the purely deductive 
argument advanced as to the causation of infectious dis- 
eases by living organisms has been staunchly supported 
during the past twenty-five years by a mass of reliable 
observations and experiments which render the doctrine 
no longer an hypothesis, or a theory, but a clearly de- 
monstrated and established fact. Upon such a strong 
foundation of fact the argument by analogy possesses 
added force in support of the micro-organic origin of 
those infectious diseases in which the specific organisms 
have not as yet been either discovered or isolated. The 
proof becomes complete and absolute when three con- 
ditions are fulfilled; these are first, the demonstration 
of the constant presence of a special or specific germ in 
association with the lesions and symptoms of the dis- 
ease; second, the isolation and cultivation of this specific 
organism by means of a series of pure cultures; third, 
the production or generation of the disease in an organ- 
ism free from it by means of the inoculation of the 
organism so isolated. The presence of all three condi- 
tions is suflicient proof, indeed most convincing proof. 



47 

Not only has the micro-organic origin of putrefaction 
and fermentation been settled beyond any possible 
shadow of doubt but the same principles have been 
more widely applied in their relations to the cause of 
disease in general. For this generalization and exten- 
sion of principles we are indebted to the illustrious 
Koch. To Schwann we are indebted for the demonstra- 
tion of the dependence of putrefaction in dead flesh up- 
on micro organisms; ta Pasteur and to Lister for the 
extension of these principles to living flesh; but to Koch 
for the extension of the principle to the specific causes 
of various infectious diseases. 

All living cells, whether of animal or vegetable 
origin, while in the conditions of active growth and de- 
velopment appropriate for their nutrition, by processes 
of selection it may be, certain desirable elements from 
among those which constitute the food with which they 
are supplied. At the same time they also excrete vari- 
ous substances which, in some cases at least, it may be 
their special and peculiar function ty produce. In the 
case of members of the higher orders of the animal and 
vegetable kingdoms these functions of secretion and ex- 
cretion may be delegated to special cells whose peculiar 
function may be the elimination of substances injurious 
to the economy or to the secretion of substances neces- 
sary its existence. For example, among the higher ani- 
mals we have the special function of the excretion of 
urea delegated to the epithelial structure of the kidneys, 
while to the mucous membrane of the stomach with its 
gjfcstrie glauds are delegated the fupctions of gaatrle 



48 



secretion so necessary to the material existence of the 
organism. The functions of which these are a type may 
be found in a simpler and possibly more modified de- 
gree in even the lower members of both kingdoms, all 
of which functions seem to serve, either directly or in- 
directly, the promotion and preservation of the health 
of the organism. Even the deadly ptomaines, so preju- 
dicial to the health and life of the unwilling host of the 
pathogenic bacteria, subserve the interest of the germ 
by paralyzing the vitality and resistive power of the 
organism upon which, and at the expense of which, it 
thrives. 

It was generally believed, until quite recently, that 
air and its contained oxygen were absolutely necessary 
to all forms of animal life. The life of a more or less 
complex organism is necessarily the sum total of the 
lives of its various component parts which are, in the 
main, animal cells. Gautier has successfully proven 
that at least one -fifth of these are anaerobic; that is, the 
generation of the vital force is not in these special 
forms dependent upon the presence of air. But whether 
dependent or not all cells excrete cetain products which 
must of necessity be expelled from the organism or else 
its vitality must succumb. Were the carbon di-oxid, 
the urea, the water or even the heat generated in the 
vital processes of the human organism allowed to accu- 
mulate either one could and would eventually destroy 
the very vitality which brought it into existence. 

Indeed the products of vital activity on the part of 
the germ or cell are exceedingly numerous and varied. 



49 



A considerable number of species possess the peculiar 
power of forming certain pigments of various shades 
and colors which may run the whole chromatic gamut 
of the solar spectrum from the violet on the one side to 
the red on the other. This fact is made use of in the 
classification and nomenclature of certain micro- 
organisms. Again, certain species have the power, 
when placed in a culture medium of gelatin, of 
liquefying the gelatine in their immediate vicini- 
ty; while others may thrive and multiply abundantly in 
the same medium without the production of such 
phenomena. Indeed this fact, as was first shown by 
Koch, is an important one in the differentiation of many 
species resembling each other in many respects. More 
over certain bacteria have the property of causing the 
development of an acid reaction in the media in which 
they are cultivated. This power may well be shown by 
adding litmus infusion to neutral or alkaline culture 
media. The change in color from blue to red, due to 
the formation of an acid, may be followed macroscopic 
ally by the naked eye. Among the acids which may be 
so produced are formic, acetic, butyric, propionic, valeric 
and many others of the group of so called ''fatty acids," 
as well as others. Then also the putrefactive decompo 
sition of proteid bodies may be effected by a great va- 
riety of micro-organisms, giving rise to as great a 
variety of products, some of which are gaseous, ephem- 
eral and exceedingly malodorous. Of course such pro- 
ducts of putrefaction vary with the nature and compo= 
sition of the body decomposed, the conditions by which 



50 

it is surrounded and by the micro organisms present 
affecting such decomposition. 

But probably the most important of all the substances 
resulting from germ life which can engage our consi 
deration are those which have been variously termed 
ptomaines, leucomaines, toxines, toxalbumins, animal 
alkaloids, putrefactive alkaloids, bacterial proteids, etc. 
The fact must have been known even to primitive man 
that the ingestion of putrid flesh was liable to affect 
the health to an extent more or less serious in nature. 
Consequently he must then have made some attempts at 
preservation, however crude; these may or may not 
have been successful, in the latter case giving rise to an 
increase in and multiplication of cases of poisoning 
from putrefactive products. These facts must have re- 
solved themselves into questions of prime importance 
very early in the history of the race, for coeval with our 
first periods of history we find definite records which 
show that man was, even at that remote time, busily 
engaged in his serious battle against the ravages of 
time, decomposition and decay. Though the facts them- 
selves were known and the causes but dimly dreamed, 
no attention was paid to the consideration of the 
products of decay themselves until the eighteenth cen- 
tury. Since then chemists have at various times isolated 
from putrefactive products, or from cultures of the bac- 
teria concerned in putrefaction, or from certain other 
pathogenic species, various nitrogenous substances re- 
sulting from the action of bacteria upon organic sub- 
Rtances; these were basic \n obaraoter md strongly ya? 



51 

sembled in nature and in chemical constitution, as well 
as physiological action, the socalled vegetable alka- 
loids — indeed they have been variously termed animal 
and putrefactive alkaloids. 

It is hardly possible even in the present advanced 
status of science to closely follow up all of the various 
chemical changes which complex histologic molecules 
may undergo, yet it is hardly sufficient to say that a 
ptomaine is the alkaloidal waste product of the cell. It 
is in reality something more than this, representing as 
it does the result of a series of cyclical changes which 
in themselves represent the tremendous cellular activ- 
ity by means of which they were engendered. However 
the essential idea is that of putrefactive change; while 
leucomaines are supposed to be those vital and essential 
and analogous alkaloids which are formed in the living 
organism and prior to its death. Some of these sub- 
stances are nontoxic while others, graphically termed 
toxines by Brieger, are extremely poisonous, even in 
minute doses. While some of them may be non-toxic 
however, yet their continual retention, accumulation and 
consequent absorption may result in serious harm, al 
though not the direct result of active toxicity. Indeed 
the products of life are largely excrementitious in char- 
acter and cannot be retained within the organism for 
any appreciable length of time with impunity. Nor- 
mally they undergo destruction or excretion by those 
ordinary physiological processes which are, in perfect 
health, in constant operation. If from any cause these 
processes are interrupted, whether that cause be emo- 



52 

tional or physical, defective absorption, oxidation or 
excretion results and the blood becomes charged with 
abnormal products; these are carried to the centres of 
life and function and the result is the institution of one 
or more of the various protean forms of disorder. 
With each and every micro organism the function of 
excretion is obligatory —indeed it is but a link in the 
completed chain of vital activity. Ptomaines and leu- 
comaines are the result, the first in the dead body and 
the second in the living body; they are residual 
products just as much as the carbon di-oxid and urea of 
the human organism. When these residual products of 
micro-organic life are once generated within the system 
the tissues seem incapable of selection, making no dis- 
tinction either as to origin or intended destination. 

The term ptomaine (a cadaver or that which has 
fallen) was first suggested by the Italian toxicologist 
Selmi as a suitable name for certain cadaveric alkaloids 
which he had isolated. Although the effect of the in- 
gestion of putrid matter upon man and the lower ani- 
mals must hav^e been observed ages ago, yet Albert von 
Haller, the distinguished physiologist, seems to have 
been the first person to institute systematic and scien 
tific experiments with a view to a more exact knowl- 
edge of the phenomena involved. He injected aqueous 
extracts of putrid matter into the veins of animals and 
found that death followed. Later in the eighteenth 
century Morand gave an account of symptoms induced 
by the eating of poisonous meat. Very little other re- 
search was indulged in until the present century. Gas- 



58 

pard (1806-— 1813) carried on experiments similar to 
those of Haller and Morand; he produced nervous dis- 
turbances, stiffness of the limbs, opisthotonos and teta- 
nus. He thought the untoward symptoms were not 
due to carbon di oxid or hydrogen sulphid, as had 
been suggested, but admitted the possibility that am- 
monia might play some part in the production of such 
symptoms. When we remember that most of the 
ptomaines are either amines or analogous compounds 
and that the first determination of their exact chemical 
nature was made by Nencki in 1876 we can hardly re- 
strain our admiration of the accuracy of this surmise of 
Gaspard which anticipated in a measure the results re- 
vealed by chemical science sixty-five years later. Ker- 
ner (1820) published his first essay upon poisonous 
sausage, followed by a second in 1822. He at first 
thought the poisonous principle to be due to the pres- 
ence of a fatty acid (which he termed caseic acid) gene- 
rated in the putrefactive process; later he thought it 
was a compound resulting from the union of the fatty 
acid and a volatile principle. Thus Gaspard and 
Kerner clearly hint at the basic character of the poison- 
ous principle of decomposition. Dupre (1822) observed 
and reported the existence of a peculiar diseese which 
existed among the soldiers of a garrison compelled to 
drink very foul water during a warm and dry summer. 
Magendie, Leuret, Dupuy and Trousseau carried on 
investigations but contributed comparatively little to 
the knowledge of the subject, Dann, Weiss, Buechner, 
Schumann, Cadet de Gassicourt and Orfila all devoted 



54 

considerable study to the active principle of poisonous 
sausage but made no advance upon Kerner's original 
work. Henneman, Huennefeld, Westrumb and Ser- 
tuerner investigated the principle of poisonous cheese; 
this however they believed to be the caseic acid of 
Kerner. Schmidt of Dorpat (1850) made researches 
into the nature of the decomposition products and vola- 
tile substances found in cholera stools. Meyer (1852) 
studied the effects produced by the injection of the 
blood and stools of cholera patients into the lower ani- 
mals. Stich (1853) discovered that putrid matter in 
sufficient quantities produced intestinal catarrh and 
choleraic stools when ingested. These were accom- 
panied by nervous tremblings and other symptoms 
together with an unsteady gait, but produced no lesions. 
He concluded from these results that putrid matter 
must contain a ferment capable of producing rapid de- 
composition of the blood. 

Panum (1856) made a most important contribution to 
the subject. He demonstrated positively the chemical 
nature of the posionous principle of putrefaction and 
showed that the aqueous extract of putrid material re- 
tained its poisonous properties even after heating and 
such treatment as would insure the destruction of organ- 
isms if present. The results thus obtained were con- 
firmed in the next ten years by Weber, Hemmer and 
Scb Wenninger. Bence Jones and Dupre (1866) obtained 
a similar body from liver. Bergmann and Schmiede- 
berg (1868) separated a poisonous substance, which they 
called sepsine, from putrid yeast and decomposing 



55 

blood. Even when administered in small doses this 
substance produced vomiting and profuse bloody diar- 
rhea in dogs and, in suflBcient doses, death. Zuelzer and 
Sonnenschein (1869) prepared a nitrogenous base from 
decomposing meat. In its chemical reactions and phys- 
iological behavior it strongly resembled atropin and 
hyoscyamin; it was also found in the bodies of those 
dead from typhoid fever and it was thought possible 
that the belladdonna like delirium of the latter stages of 
the disease might be caused by an ante-mortem genera- 
tion of the poison within the body. Though many ef- 
forts had been made to isolate as well as to produce 
these peculiar substances such isolation was first suc- 
cessfully accomplished by Francesco Selmi (1873-1876). 
He made extensive and valuable researches, it is true, 
but remained in ignorance of the chemical constitution 
and composition of the bodies which he had isolated. 
Indeed Nencki (1876) made the first ultimate chemical 
analysis and determined the first chemical formula for 
a ptomaine; this was an isomer of collodioe. Roersch 
and Fassbender obtained in a case of suspected poison- 
ing a liquid which could be extracted by ether from 
either acid or alkaline solutions; it gave all of the char- 
acteristic alkaloidal reactions, resembling digitalin in 
particular. Gunning found the same alkaloid in liver- 
sausage, from which poisoning had occurred. From 
human bodies which had been dead for several months 
Selmi removed many alkaloidal bases; one was found 
to be a very violent poison, producing in rabbits 
tetanus, marked dilatation of the pupils, paralysis and 



5{> 

death. Lombroso (1871) showed that the extract from 
mouldy corn meal produced tetanic convulsions in ani- 
mals. These investigations threw some light upon the 
causes of sporadic cases of illness among the peasants 
of Lombardy who eat fermenting and mouldy corn meal. 
In 181 6 Brugnatelli and Zenoni obtained an alkaloidal 
substance from this mouldy meal. Guareschi and 
Mosso obtained various volatile and non-volatile bases 
from decomposing human brains. Brieger of Berlin 
isolated and determined the composition of a number of 
ptomaines and in 1885 published a valuable work upon 
the subject. From pure cultures of the typhoid bacillus 
of Eberth and Koch he obtained a poison (typhotoxine) 
and from similar cultures of the tetanus germ of Rosen- 
bach he produced a similar body (tetanine). Brieger 
calls special attention to the fact that most of the char- 
acteristic ptomaines are diamines; that chemically they 
are more simple in composition than the vegetable alka 
loids, which they resemble, and that many of theptoma 
ines are derivatives of hydro-carbons of the ethylene 
series and are in distinction from true alkaloids rep- 
resenting the pyridine group. Vaughan, who is by far 
the leading American authority upon the subject of pto- 
moines, isolated in 1884-1885 an active agent (tyrotox- 
ican) from poisonous cheese. Koch and others demon- 
strated the presence of a poisonous substance in cultures 
of the cholera bacillus; Hoffa did the same in the 
case of the anthrax bacillus. Hankin (1889) isolated a 
toxie albumose from cultures of the anthrax bacillus 
which proved fatal in quaaties but in small doses af 



forded immunity » The investigations of the past few 
years have been mainly in the direction indicated by the 
results of Hankin. Now the fact that a germ is patho 
genie is considered to be sufficient evidence of the fact 
that it elaborates poisonous products and the study of 
these products is justly regarded as one of the greatest 
importance in the investigation of the germ and the 
disease which it causes. The interest in the subject is 
not confined alone to the study of the aetiology of dis- 
ease but strenuous efforts are being made with a view 
towards the securing of immunity from disease and in- 
deed even to effect cures of disease by means of the use 
of these self-same bacterial products. If the excrement- 
itious products of the human organism possess the 
power, when retained, of ultimately destroying the life 
or impairing the health of that organism, why should 
not such be true also of the germ which likewise gener- 
ates* excrementitious products? Our knowledge of the 
latter conditions is as yet in the embryonic stage, but 
to that knowledge, crude and imperfect as it is, we owe 
the tuberculin of Koch, the anti-cholerine of Klebs, the 
pneumotoxine, typhotoxine, etc., which though not as 
successful and infallible as enthusissm had anticipated, 
yet in spite of their crudities and imperfections, suc- 
ceeded in making a vast and manifest stride in the 
proper direction; when they failed they taught lessons 
as valuable as those imparted by their successes. In this 
direction lies the domain of the medicine of the future; 
in this direction Science points with inexorable finger. 
Who can predicate the successes of the future which 



58 

lie as yet unborn within the matrix of Eternity? 

Indeed we may now regard it as conclusively proven 
that the pathogenic power of those bacteria instrumental 
in the development of so many and various infectious 
diseases in man and the lower of animals is largely if 
not entirely dependent upon their power of producing 
toxic ptomaines or toxalbumins. They may affect the 
organism directly or indirectly by the medium of the 
food or ingested articles. That is, the toxic substances 
may be produced within the body by septic or other 
processes and then after absorption give rise to systemic 
infection. Or the products may be elaborated in such 
articles as cheese, milk meat, etc., and the toxic pro- 
ducts resulting from an extraneous action may upon in- 
gestion give rise to symptoms strongly resembling in 
their dangerous and alarming nature the characteristics 
of acute alkaloidal poisoning. 

The field of research in the direction of the therapeu 
tic applications and value of the products of vital bac- 
terial activity lies almost fallow. Its primitive cultiva- 
tion has afforded such rich fruit that we are justified in 
looking to it for an abundant harvest. When Science 
shall have placed within the hands of the physician 
those potent weapons which the germ itself uses with 
such deadly effect, then shall begin such a battle with 
disease as the world has never witnessed and then shall 
ensue a victory which shall be not more glorious than 
complete. 




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59 



VI. — Infection, Susceptibility and Immunity. 



The human organism is exposed to infection of vari- 
ous kinds at every point. The infection of open and 
exposed wounds is, or rather was, a thing of daily oc- 
currence; thanks however to the principles of antiseptic 
and aseptic surgery the occurrence or formation of pus 
at the present day is comparatively rare under proper 
treatment and is really nothing more nor less than an 
evidence of the ignorance or carelessness of the physi- 
cian or surgeon in charge Schimmelbusch has definite- 
ly proven in his experiments with the Staphylococcus 
pyogenes aureus^ JSacillus authracis and other micro- 
organisms that infection is undoubtedly possible through 
the channel of the unbroken skin. MachnoflE in his ex- 
periments with the effects of the Bacillus authracis 
upon guinea pigs came to the same conclusion. Indeed 
these results have been further confirmed by the results 
obtained by Roth, Braunschweig, Ribbert and others. 

Buechner instituted researches for the purpose of 
determining the possibility of infection through the 
channel of the intestinal mucous membrane. For this 
purpose he used mice and guinea pigs and fed them up- 
on anthrax spores. In four cases out of thirty-three 
positive results were obtained, that is, the disease devel- 
oped. This definitely proves that while infection does 
not necessarily follow the ingestion of infected material, 
it is nevertheless posible. Indeed it is more than ex- 



60 

ceedingly probably that this is the usual mode of infec 
tion in typhoid fever. 

Buechner also made experiments with a view to test- 
ing the possibility of infection by means of the mucous 
membrane of the respiratory tract. In these experiments 
he obtained positive results in fifty cases out of sixty six, 
—showing that the chances of infection by the channel of 
mucous membrane of the respiratory tract are greater 
than in the case of the intestinal tract. The possibility 
of infection by the former channel is substantiated by 
the disease termed **wool sorter's disease"; here the in- 
fectious material set free by the handling of infected 
wool is inspired by the sorter, instituting the peculiar 
disease. Hildebrandt has experimentally demonstrated 
that under ordinary circumstances the majority of bac 
teria suspended in the air do not reach the lungs or 
even the trachea, but are usually deposited upon the 
mucous membrane of the mouth, nares or fauces; but 
that in prolonged respiration in an atmosphere so charg- 
ed with bacteria, the micro organisms may be found 
deposited in the lungs. This may probably explain, in 
some degree, the relative frequency with which laryn- 
geal or pharyngeal tuberculosis accompanies the pul- 
monary form of the disease, especially its jjiore virulent 
forms. 

In general however, we may say that man is most 
frequently attacked by the infectious diseases through 
the media of the alimentary canal, the circulatory or 
lymphatic systems and the respiratory tract. The gas- 
tric ]uice and the absorbent cells of the stomach and 



61 



intestinal tract afford physiological guards against in- 
fection by means of the alimentary canal; hence, sus- 
ceptibility to the various infectious intestinal diseases 
must depend, to a certain extent, upon those causes 
which render the physiological guards defective. All 
germs which have the power of generating- toxic sub- 
stances are dangerous when introduced into the intesti- 
nal canal; this is dependent upon their capability of 
producing chemical poisons which are usually proteid 
in character and probably produce their objectionable 
actions by virtue of some process of catalysis. When 
the complex cellular molecules are split up, simpler ones 
are formed ; but the chemical action implies the genera- 
tion of a certain amount of heat and hence fever is the 
most common and predominant manifestation. 

The physiological guards against infection through 
the channel of the blood or of the lymph lies in the germi- 
cidal powers of the proteids of these fluids and suscepti 
bility to infection by such channels is, to a certain ex- 
tent, dependent upon the impoverishment of the fluids. 
Hence the treatment of consumption and other similar 
diseases by means of liberal diet, constitutional remedies 
and plenty of exercise in the open air is founded upon a 
true and proper scientific basis and is not purely empir- 
ical in character. 

It has long been known and observed that certain 
species are specially predisposed to certain diseases 
while other species enjoy more or less immunity to the 
same. Thus man is especially subject to attacks of such 
diseases as typhoid fever, relapsing fever, cholera and 



62 

others while the lower animals do not suffer at all with 
them. On the other hand man possesses immunity to 
many of the infectious diseases of the lower animals. 
Immunity to disease may also be racial in character. 
For instance the negro is decidedly less subject to yel- 
low fever than is the white man, but on the other hand 
he is especially susceptible to small pox. Then again, 
Algerian sheep are immune to anthrax, a disease which 
is markedly fatal among other sheep Immunity may 
also be individual in character; thus we have certain 
diseases, of an exanthematous type especially, to which 
adults seem more or less immune but to which children 
possess such a marked and peculiar susceptibility that 
such are frequently termed ^^children^s diseases." 

The most essential, indeed the essential difference 
between a suceptible animal and an immune animal lies 
in the fact that in the one the pathogenic germ invades 
the tissues and multiples, producing certain changes in 
the tissues and fluids of the animal so infected which 
prove prejudicial to its life or health. In the immune 
animal on the other hand even though invasion is ac- 
complished, multiplication does not usually occur, or if 
it does it is restricted to a circumscribed area in which 
the invader is ultimately destroyed by the operation of 
the natural processes. The question then resolves itself 
into this — in what consists this difference, or upon what 
does it depend? The question is a simple one, it is true, 
but its solution has been fraught with much labor. 
Upon what does this difference depend? Surely not 
upon the germ, for that is, as it were, a common factor 



63 

in each case, whether it be of susceptibility on the one 
hand or immunity on the other. It must then depend 
upon conditions of some kind surrounding the germ and 
which are either favorable or unfavorable to its develop- 
ment. 

As early as the year 1881 Sternberg suggested that 
the leucocytes might pick up, assimilate and dispose of 
bacterial organisms. This suggestion was based upon 
the observation that leucocytes did take up inorganic 
granules, that bacteria had been found within their sub- 
stance and also that amoebae fed upon bacteria and 
similar organisms. 1884 Metschnikoff took the idea up 
and elaborated it, suggesting the name of phagocytosis 
for this so called function of leucocytes, which was based 
upon the idea that the phagocyte actually ate up the 
micro-organism which it took within its substance. 
Baumgarten, Weigert and others suggested that perhaps 
the bacteria observed within the substance of the leuco- 
cytes may have been already dead when picked up, hav- 
ing been destroyed outside of the white blood-corpuscle. 
Indeed we now have the conclusive experimental evi- 
dence of Buechner and others that blood-serum posses- 
ses considerable germicidal power independent of its cell- 
ular constituents. 

It seems then that the cells of the animal body must 
be concerned in the production of this condition called 
immunity, this may be either the result of direct or in- 
direct action; that is, either the cells may possess this 
power or they may contain or elaborate a substance 
vested with such powers. Immunity may be acquired 



64 

or natural. Among the best examples of the natural 
variety we might cite the case of the immunity of the 
common rat, the frog, the dog and the common domestic 
fowl to anthrax. The chick from the earliest period of 
its existence is naturally immune to even the most vir- 
ulent cultures of the anthrax bacillus, as has been de- 
monstrated by Lazarus and Weyl. True it is that a 
susceptibility may be induced artificially but this is 
practically but a perversion of natural properties. Racial 
immunity is supposed to be more or less due to an ac- 
quired tolerance due to processes of natural selection 
and inheritance. This, it is claimed bv some, results 
naturally from an application of the law of the survival 
of the fittest as well as that of the law of heredity. In this 
view of the subject it is supposed that the feebler cells are 
killed or destroyed in the struggle for existence and that 
when recovery supervenes the body resumes its normal 
functional activity. But now it will contain the pro- 
geny of those cells whioh were originally strong enough 
to resist the effect of that particular disease through 
which it has passed. It is but natural to suppose that 
those parent cells have transmitted their qualities to 
to their offspring. Thus it is rather by a death of the 
weaker and less resistive cells than by an acquisition of 
new powers on the part of the surviving cells that im- 
munity is afforded. The strong survive by virtue of 
their strength and this tends to perpetuate and improve 
the species. Certain it is that animals transmit their 
personal peculiarities to their prcgeny — and what is an 
animal but a collection of cells, the sum total of whose 



65 

vitalities forms the vitality of the animal? If this is 
true of a collection or aggregation of cells, may it not 
be also true of a single cell? It is certainly plausible 
to believe that properties already possessed by cells may 
be transmitted to their descendants, for the transmission 
of congenital traits seems established beyond a perad- 
venture. Oar conclusion then must be that immunity, 
where it exists racially, is due to inherent properties of 
the parent cell and their natural development with that 
of functional activity; also that these properties may be 
transmitted to their pregeny. 

The natural immunity which is peculiar to the individ- 
ual usually becomes more prominent or active with 
adolescence or adult life. Thus the young rat is sus- 
ceptible to anthrax while the adult is immune and can 
only be rendered susceptible by redu3ing, in some man- 
ner, the vital strength or resistive power. Again, the 
child is highly susceptible to those peculiar diseases 
called "children's diseases," such as scarlatina, diphthe- 
ria and the acute exanthems; the adult, while not en- 
tirely immune, possesses little susceptibility. This 
seems to be in some way dependent upon a higher vital 
resistive power, lor the adult does not usually contract 
the disease unless exposed to it for a long period or else 
reduced in vitality. As Vaughan says: ''The only 
resonable explanation of this immunity is that it is in- 
herent in the parent cell and comes as naturally as the 
changes m form and voice at puberty or as the growth 
of the beard in early manhood." If this be so then w^e 
may reasonably conclude that immunity is, in all prob 



66 

ability, one of the phenomena, inherent in the vital acti- 
vity of certain cells. 

Lewis and D. Cunningham, as early as 1872, showed 
that bacteria rapidly disappear when injected into the 
circulation. 

In 1874 Traube and Gschiedlen demonstrated that 
when arterial blood, under antiseptic precautions, was 
taken from a rabbit, into whose jugular vein a fluid 
rich in putrefactive germs had been injected forty-eight 
hours previously, it failed to undergo decomposition 
for months. These germicidal properties they errone- 
ously attributed to the "ozonized oxygen" of the blood. 

Wyssokowicz had also noticed that bacteria rapidly 
disappeared from the circulation when injected therein; 
he stated that this was due to their deposition in the 
capillaries of the tissues. 

Grohmann and Schmidt experimented with extra- 
vascular blood and found that anthrax bacilli which had 
been kept in plasma were modified in virulence; this 
they attributed to the process of coagulation. 

Fodor (1887) combated the theory of Wyssokowicz 
that the disappearance of bacteria from the circulation 
was due to their deposition and retention in the capil- 
laries. He proved that blood freshly drawn from the 
heart possesses consiberable germicidal power; that even 
when kept without the body, in blood in a pipette, the 
germs rapidly diminished in number. After awhile the 
blood seemed to lose its germicidal properties and there 
followed an increase in the number of germs. 

In the next year Nuttall demonstrated the power of 



67 

defibrinated blood to destroy various pathogenic and 
nonpathogenic organisms. He also confirmed Fodor's 
conclusion that after a time blood loses its germicidal 
properties and then becomes an excellent culture 
medium. 

Behring has shown that the blood of various animals 
differs in the intensity of germicidal powers — thus in 
some cases it was found to be decided in the case of 
certain pathogenic bacteria, less so for others and abso- 
lutely lacking in the case of certain common saprophy- 
teSi He demonstrated that the blood of the rat and 
frog, which possess special immunity to anthrax, is 
especially fatal to the anthrax bacillus. While this 
germicidal action is very prompt it is very limited and 
when the number of germs is excessive, development 
may follow an interval of limited destruction — thus it 
seems that the power is ultimately neutralized or exhaust- 
ed after its exercise for a definite period. These results 
were somewhat similar to those of Fodor and Nuttall. 

Buechner, Voit, Sittmann and Orthenberger made 
most exhaustive researches into the germicidal proper- 
ties of blood and (1890) made a most valuable and im- 
portant contribution to the subject. The work of these 
investigators is of such importance that a statement of 
the results of their work is justifiable; they may be 
tersely summed up as follows: 

1. The germicidal action of blood is not due to 
phagocytes, because it is not influenced by the alternate 
freezing and thawing of the blood, by which the leuco- 
cytes of the rabbit are destroyed. 



68 

2. The germicidal properties of the cell-free serum 
must be due to its soluble constituents. 

3. Neither Deutralization of the serum, nor the addition 
of pepsin, nor the removal of carbon di oxide gas, nor 
treatment with oxygen has any effect upon the germi- 
cidal properties of the blood. 

4. Dialysis of the serum against water destroys its 
activity, while dialysis against 0.75 percent salt solution 
does not. In the diffusate there is no germicidal sub- 
stance. The loss by dialysis with water must be due 
to the withdrawal of the inorganic salts of the serum. 

5. The same is shown to be the case when the serum 
is diluted with water and when it is diluted with salt 
solution. In the former instance the germicidal action 
is destroyed, while in the latter it is not. 

6. The inorganic salts have in and of themselves no 
germicidal action. They are active only in so far as 
they affect the normal properties of the albuminates of 
the serum. The germicidal properties of the serum 
reside in its albuminous constituents. 

7. The difference in the effects of the active serum 
and that which has been heated to 55°C. is due to the 
altered condition of the albuminate. The difference 
may possibly be a chemical one (due to changes within 
the molecule) or it may be due to alterations in mycelial 
structure. The albuminous bodies act upon the bacteria 
only when the former are in active state. 

Vaughan in commenting on these results says: *^We 
wish at this point to call attention to an inconsistency 
between the results obtained by Buechner and the con- 



69 

elusion that he draws. In experiment No. 45 he renders 
the serum slightly acid and adds 0.1 gram of pepsin to 
each five c. c. of serum (showing by a side experiment 
that this pepsin actively digests coagulated egg albumin 
in neutral solution) and finds that the digestive action 
of the pepsin does not lessen the germicidal properties 
of the serum. In fact he states this in his conclusions, 
but his ultimate opinion, and the one held by him in 
his latest contribution, is that the germicidal constituent 
of the blood is the serum albumin. How much serum- 
albumin remains in blood serum after it has been 
thoroughly digested with pepsin? He could scarcely 
have chosen a more positive method of demonstrating 
that the germicidal constituent is not serum-albumin. 
Either his pepsin was not active, (Mr. Vaughan seems 
to forget that it was expressly stated that a control ex- 
periment demonstrated the activity of the pepsin in its 
ability to digest coagulated egg-albumin. However, 
this does not affect his argument or its truth in the 
slightest degree.) and on this supposition his experiment 
is without value, or the active constituent of blood- 
serum is a substance that is not destroyed or mateiially 
altered by peptic digestion. We know that the pep- 
tones not only have no germicidal properties, but that 
they belong to that class of proteids that is most favor- 
able to the growth and development of germs. We re- 
cognize this fact when we add peptones to the various 
artificial media on which we cultivate germs." This 
objection of Vaughan's certainly appears to us to be 
well taken, nevertheless the fact remains that the results 



70 

aDnounced by these observers are among the most im- 
portant that have been made upon the subject. Indeed 
the success with which they met induced many others 
to enter this new field of research. The result is that 
although much useful information as to the germicidal 
powers of the blood under various conditions has been 
thereby elucidated yet as far as the exact nature of that 
germicidal constitutent is concerned but little or no 
progress was made— if we except the comparatively re- 
cent and masterly collaborations of Vaughan, Novy and 
McClintock. Behring and Nissen obtained results 
which seem to indicate that the action of blood within 
the natural channels and that of extra-vascular blood is 
vastly different. Pekelharing's experiments proved that 
the disappearence of anthrax spores, enclosed within 
parchment, when introduced beneath the skin of rabbits 
was not due to phagocytes but to some soluble poisonous 
substance. Halliburton separated a cell-globulin from 
lymphatic glands; Hankin found that this substance 
possesses marked germicidal properties. Christmas 
also prepared a germicidal substance from the spleen 
and other organs. 

Attempts have been made also to determine the exact 
nature of this germicidal constituent of the blood and 
tissues by the action of precipitating reagents upon the 
proteids of blood-serum. Buechner, Christmas, Bitter, 
Emmerich, Tsuboi, Steinmetz, Loew and others have 
given much attention to the subject. 

Fodor and Zuntz had shown some time ago that freshly 
drawn blood decreases rapidly in alkalinity upon stand- 



71 

ing, just as it seems to lose in germicidal powers. In- 
deed Behring had suggested that the action of the blood 
of the white rat upon anthrax bacilli was due to its 
great alkalinity. Vaughan too has suggested that the 
blood of the adult rat, which is not susceptible to an- 
thrax, is more alkaline than that of the young rat, which 
is susceptible to the disease. Emmerich and his co- 
workers demonstrated that blood-serum rendered faintly 
acid not only has no germicidal power but furnishes a 
good culture-medium. Behring demonstrated that the 
white rat lost his immunity to anthrax when the acid 
phosphate of calcium was mixed with its food in quan- 
tities sufficient to neutralize the alkalinity of the 
blood; Fodor also demonstrated that the resistance of 
rabbits to anthrax was markedly increased after the 
administration of sodium phosphate or of the alkaline 
carbonates. In 1887 he had noticed that after awhile 
infected blood lost its germicidal properties and became 
an excellent culture medium. May this not have been 
due to a loss of alkalinity, dependent upon the forma- 
tion of acid products and subsequent neutralization of 
the natural alkalization ? Certainly it is proven that 
bacterial activity may generate many and various acids, 
such as formic, acetic, butyric, propionic, lactic, etc. 

Hankin, in a paper published in the past year, sug- 
gests that the germicidal substance is a special secretion 
of the eosinophile granular cells; according to his the- 
ory the granular matter of these cells is the antecedent 
of the germicidal substance, 



72 

' In summing up the evidence we may summarize as 
follows: 

1. It has been incontestabiy proven that blood-serum 
contains a substance which possesses considerable 
germicidal power. 

2. Buechner has demonstrated that pepsin does not 
affect or extract the active germicidal constituent from 
blood serum; ergo, this active constituent cannot be 
serum albumin, because pepsin converts it into peptone 
which is especially favorable to the development of 
germ life. 

3. A temperature of 55*^C., as Buechner and others 
have demonstrated, destroys or impairs the germicidal 
activity of blood-serum. It is probable then that the 
substance is a proteid. 

Vaugban adds to these a statement that the only 
proteid likely to be present in blood-serum, and which 
is not destroyed by peptic digestion, is nuclein. This 
conclusion would be rendered probable if he could iso- 
late the nucleins themselves and demonstrate that they 
possess germicidal properties — if the residue remained 
inert it would strongly coniirm the iirst result. To the 
solution of these questions Vaughan has given consider 
able time and attention. The results which he has ob- 
tained are exceedingly striking and hardly less than 
convincing. SuflSce it to say that he has demonstrated 
that blood serum does contain a nuclein— he asks the in- 
teresting question, does it come from the disintegration 
of the pol J nuclear cells, or shall we regard certain 
white blood corpuscles as unicellular organs whose 



function it is to secrete this nuclein? He has demon- 
strated by repeated experiments that this nuclein pos- 
sesses considerable germicidal power. He has also 
made many experiments with various nucieins extracted 
from the testes, the thyroid gland and yeast cells and 
proves conclusively that they likewise possess marked 
spermicidal power. Indeed it now seems that immunity 
depends largely upon cell-nucleins, as well as upon the 
reaction and composition of the fluids of the body, 
upon vital resistive power and cellular activity. Wool- 
dridge of England has also obtained results which seem 
but to confirm those of Vaughan. to whom we owe a 
large part of our present knowledge of the subject. 

The fact that the germicidal constituent of the blood- 
serum can be isolated and utilized has an important 
bearing upon therapeutics, — indeed it is exceedingly 
analogous to the advance which was made when it 
became possible to extract the active alkaloidal prin- 
ciples from crude drugs. Blood-serum therapy has 
been proven impracticable not on account of a lack of 
virtue but because of the large amount of the fluid 
which it is necessary to inject in order to secure favor- 
able results. The isolation and use of nuclein now 
seems to indicate a method of avoiding this difficulty — 
it is even hinted that the future may witness the use of 
the various nucieins as therapeutic agents in the treat- 
ment of disease. 

But persons or animals naturally susceptible to dis- 
ease may, by means of certain processes, secure an im- 
munity, usually termed acquired in contradistinction to 



74 

that which exists naturally in some species, races or in- 
dividuals. It has long been a well-known fact that 
certain of the infectious diseases, such as typhoid fever, 
yellow fever, parotitis, pertussis, etc. confer upon the 
individual so infected a freedom from or immunity to 
subsequent development; this immunity while general 
is not always absolute. 

Certain other infectious diseases such as epidemic in- 
fluenza, croup, pneumonia, Asiatic cholera, etc. do not 
confer immunity against subsequent attacks. It is ex- 
ceedingly probable, however, that in this latter case a 
certain degree of immunity of a limited duration is 
afforded, because we seldom have an individual stricken 
with these diseases twice during the same epidemic. If 
such immunity is afforded it must be transient in nature. 
Even that afforded by the first class of diseases is not 
everlasting in its effects, for a man may have small-pox 
a second time if several years have elapsed since the 
first attack and provided also tha*i the second exposure 
brings him in contact with a virulent form of infection 
or consists of an exposure through an unusually long 
period or at a time when health and vitality are im- 
paired by any cause. Until the discoverj'^ of Jenner the 
only form of acquired immunity known was that ob- 
tained or conferred by an actual attack of the disease 
ending in recovery. We now know at the present time 
that immunity is also conferred by vaccination with a 
modified form of infection; b)^ the introduction of a 
small number of virulent germs followed by a succes- 
sive inoculations with larger numbers until a tolerance. 



75 

as it were, is established; and by treatments with 
sterilized germ-culturesc 

Pasteur (1880) produced immunity by inducing a 
mild attack by means of an injection of attenuated cul- 
tures. He, in this way, made successful inoculations 
against chicken-cholera and anthrax. Emmerich and 
his pupils succeeded in immunizing animals to swine- 
erysipelas by employing small numbers of the virulent 
germs and gradually increasing the dose. This is prac- 
tically the rationale of Pasteur's method in rabies. 
However, the immunity consequent upon inoculation 
with a germ full of virulence is not only more marked 
than in the case of the use of modified or attenuated 
cultures but is also more lasting in its effect. Ogata 
and Jasuhara have fully demonstrated the fact that 
anthrax cultures in the blood of an immune animal 
(such as the rat, dog or frog) become attenuated as far 
as their pathogenic power is concerned. Also that in- 
jection of these cultures, so attenuated, into the blood 
of a susceptible animal gives rise to a mild attack fol- 
lowed by immunity. Moreover that if even a drop of 
blood from the dog or frog be injected into a mouse, 
before or after the latter is inoculated with a virulent 
culture of the anthrax bacillus, that it proves protective 
against a fatal attack, the mild attack thus induced 
being followed by immunity. Similar results have been 
attained by Behring and Kitasato. 

Tizzoni aud Cattani fnid that in the case of tetanus, 
the blood-serum of an immune animal will protect 
either against^the living germ or the germ-free culture. 



76 

Salmon and Smith (1886) succeeded in rendering 
pigeons immune to hog cholera by inoculations with 
sterilized cultures of the bacilli. Roux (1888) obtained 
similar results in the case of anthrax and Behring and 
Kitasato in the case of tetanus and diphtheria. 

Fraenkel determined that 10-20 c. c. of a three- weeks 
old culture of diphtheria babillus, if heated to 65° or 
70° for one hour, and then injected into a guinea-pig, 
secures immunity against subsequent inoculations by 
the virulent germ if such subsequent inoculations 
are not made sooner than the fourteenth day after 
treatment by the sterilized culture. He declares that 
in his opinion the cultures contain two special albumin- 
ous bodies, one toxic in nature and destroyed or ren- 
dered innocuous by a temperature of 65°-70° C and the 
other conferring immunity yet retaining its properties 
at that temperature. 

Tizzoni, Cattani, Klemperer, Ogata, Jasuhara, Kita- 
sato, Behring, Buechner and others hold to a belief 
that some substance is formed in the blood of the im- 
mune animal and that this substance has the peculiar 
power of neutralizing the toxic products of pathogenic 
micro organisms. Some conclude that this eftect is not 
due to ptomaines but to proteids, though the latter need 
not necessarily be direct products of the germ against 
which immunity is sought nor indeed even necessarily 
of bacterial origin. Others however hold that this im- 
munity-conferring substance partakes of the nature of 
an antitoxin. Sternberg says on this point: ''The 
experimental evidence detailed gives strong support to 



77 

the view that acquired immunity depends upon the for- 
mation of antitoxic 68 in the bodies of immune animals. 
As secondary factors it is probable that tolerance to the 
toxic products of pathogenic bacteria and phagocytosis 
have considerable importance, but it is evident that the 
principal role cannot be assigned to these agencies.'' 

Others, like Vaaghan, Novy, McClintock and Wool 
drige, believe immunity resides within the cell sub- 
stance, and cite the germicidal power of the nucleins 
of blood, testicle, thyroid gland, yeast and other cells. 
Their side of the question is certainly upheld by ex 
perimental proof at least as strong as that of those ad- 
vancing the antitoxin theory alone. 

If a sterilized culture affords immunity what consti- 
tuent of it possesses this peculiar property? All are 
agreed that it is not the function of ptomaines. 
Vaughan says strikingly: 

"We can answer the question as to which constituent 
of sterilized cultures gives immunity with considerable 
confidence if we recognize the following facts: 

1. Marked artificial immunity to an infectious disease 
has not been obtained except by the introduction into 
the animal of the germ substance, either enclosed in the 
cell wall or in solution. 

2. Sterilized cultures contain the germ substance in 
one or both of these forms. 

3. The same immunizing substance exists in the 
bodies of bacteria grown on solid media and killed by 
the action of chloroform. 

4. The same immunizing effects, varying, however, 



78 

in degree, are obtained with the bodies of the dead 
bacteria morphologically intact or in solution, with 
living bacteria modified and reduced in virulence and 
with very small numbers of the virulent germ." 

From this he very logically concludes that the immun- 
izing substance is a constituent of the bacterial cell 
itself; and further that as each kind of germ has its 
own peculiar poison, conferring immunity when ex 
hibited in small doses; the poison cannot come from the 
cell wall, nor can it be a decomposition product of bac- 
terial activity but an essential, characteristic portion of 
the cell itself, to which is due its distinctive properties. 
He believes this to be the nuclein. Certainly his prem 
ises are peculiarly upheld by facts, for all of the 
methods of producing immunity depend upon the in- 
troduction of the germ- substance into the body. Immu- 
nity conferred by an attack of disease is certainly 
caused by an introduction of germs which are not only 
living but more or less active in virulence. That which 
is induced by vaccination or inoculation by attenuated 
cultures is due to the introduction of germs which are 
living but whose virulent activity is more or less modi- 
fied or reduced. That which is induced by inoculation 
with sterilized cultures is due to the introduction of 
the germ substance (or as Vaughan says, the germ- 
nuclein) so modified that it is no longer capable of re- 
production. 

True it is that a susceptible animal may be rendered 
immune by treatment with the blood serum of an im- 
mune ^animal. For example a ^horse is rendered im- 



79 

mune to tetanus by treatment with the modiiied bac- 
terial proteid and from these treatments it results that 
an immunity-conferring substance is generated within 
the horse and circulates in its blood. If now this 
blood-serum of the horse be injected into a mouse the 
animal becomes, under certain conditions immunized to 
tetanus. But as Vaughan most aptly says — "The im- 
munity actually does not belong to the mouse. It still 
belongs to the horse. It is stolen property and will soon 
be lost,^^ The immunity-conferring substance is formed 
by the cells of the horse not of the mouse. Behring 
says that subsequent inoculation of the mouse may 
awaken its cell activity and the immunity which then 
results is the direct property of the mouse, but this does 
not become true prior to the ijitroduction of the germ. 

Upon what does the inciting cause act in the pro- 
duction of immunity? Tizzoni and Cattani have demon- 
strated that rabbits cannot be immunized to tetanus 
after removal of the spleen. Lindemann and others 
have shown that a dog which has undergone extir- 
pation of the thyroid gland will not stand the doses of 
caffein which the same dog was able to bear prior to ex- 
tirpation. The effects of extirpation, or atrophy of the 
thyroid gland, are now well known, as are also the bril- 
liant results following the administration of the gland 
in certain diseases. It is suggested that these organs 
are the sources of nucleated leucocytes, — these differ 
from the red corpuscles in that they possess nuclei. 
This naturally suggested that nuclein might play an im- 
portant role in the production of immunity. This 



80 

thought occured to Brieger, Wasserman and Kitasato; 
they obtained negative results but is is significant that 
they used a temperature of 100° C in the elaboration of 
their preparations— we know now that a temperature of 
55® C seriously impairs indeed almost destroys their 
virtues. Wooldridge of England, whose work seems to 
have been entirely overlooked, obtained very favorable 
results as indeed has Vaughan even more recently. We 
may now consider it conclusively proven that the blood- 
serum, thyroid gland, spleen, marrow of bones, etc. have 
considerable germicidal power and this power is possessed 
by their nucleins. That the nucleins do exert a powerful 
influence in immunity Tizzoni and Cattani have shown 
by failures to produce immunization of rabbits to teta- 
nus when the spleen had been removed. We now know 
that Nature has provided special physiological guards 
against infection by the ordinary channels and further 
that she has supplied general physiological guards in 
the nucleins whose germicidal power is dependent 
largely upon vital cellular activity. This forces us to 
the conclusion that immunity is in a large measure due 
to the production of antagonistic substances which are 
produced by the stimulation of certain organs, chiefly 
the spleen, the thyroid gland and marrow of bones 
which manufacture nucleins^ — does it not seem reason- 
able then that these antidotal sub&tances should be 
nucleins? Their kind and amount then would depend 
upon the nature of the incitant and the organ or organs 
specially incited. This would indicate that the pro- 
cesses of Nature are eminently conservative, that they 



81 . 

are constantly striving for the attainment of such an 
ideal state of health as would render the system proof 
against hostile attacks of pathogenic organisms. It is a 
question whether this end might not be attained were it 
not for our vitiation and antagonism of Nature's own 
efforts by our habits and frequent infractions of all 
hygienic law. Clearly then anything which depresses 
vitality predisposes to susceptibility to disease whiJe it 
is only to an exaltation of vitality that we can look for 
immunity. 



VII. — Antiseptics and Theik Relative Value, 



Antisepsis is a condition in which the development 
of micro-organic life is retarded or rather prevented. 
The germ is not necessarily destroyed or killed; it is 
sufficient simply to arrest and prevent its development, 
its power of exercising the reproductive functionB. An 
antiseptic is an agent capable of preventing putrefac- 
tlon, that is, the growth of those organisms which cause 
putrefaction, if the agent also possesses the power to 
kill or c/^s^roy organisms, it is germicidal in effect al- 
though, of course, antiseptic; because a substance which 
possesses the power of destroying the organisms which 
cause putrefaction possesses the power, ipso facto^ of 
preventing putrefaction. All^germieides are necessarily 



82 

antiseptics but all antiseptics are not necessarily germi- 
cides — all potatoes are vegetables but all vegetables are 
not necessarily potatoes. In order to demonstrate 
antiseptic power it is only necessary to demonstrate or 
show that the substance is capable of preventing the 
exercise of those functions of bacterial activity which 
usually result in decay or putrefaction. The germ is 
thus rendered innocuous or harmless by inhibition of 
its normal vital activity. When the inhibiting condi- 
tion, the actual presence of an antiseptic substance, is 
removed then the interrupted processes may supervene. 
Thus alcohol, sodic chlorid, sodic tetraborate^ ferrous 
sulphate and many other substances commonly used as 
germicides do not, even in concentrated solutions, de- 
stroy the spores of various germs, hence they are not 
true germicides. The true germicide kills or destroys 
the microbean element, rendering future development 
an impossibility except by renewed infection. The ac- 
tion of an antiseptic is very similar to that of judicial 
incarceration, in which the offending entity is isolated 
and shorn of his social and political functions — he is 
rendered incapable of doing harm, Germicidal action 
on the other hand is somewhat analogous to judicial 
execution — the offending entity is destroyed. An anti- 
septic substance must not only have the power of pre- 
venting the growth of putrefactive organisms but must 
also be capable of exercising such restrictive power 
even in culture media favorable to their growth, devel- 
opment and proliferation. 

So many persons discuss asepsis and antisepsis as 



though antithetical terms. Asepsis is, of course, a de* 
sirable, an ideal condition and antisepsis is a means to 
that end. Most wounds and injuries are infected be- 
fore coming under the care of the physician or surgeon, 
there is no possibility of asepsis, in a strict sense. The 
germ has already gained access, no opportunity having 
been offered ihe physician to exclude it. Infection is so 
exceedingly insidious, even in conditions where every- 
thing seems favorable to the success of aseptic proced- 
ures, that it certainly seems rational to err, if at all, up- 
on the safe side by a conjunction of asepsis and anti- 
sepsis. In so called aseptic procedures everything is 
dependent upon sterilized dressings, sterilized instru- 
ments — sterilized by what means? Either by the anti- 
septic action of moist heat or by the use of antiseptics 
themselves. It is exceedingly difficult to say where 
asepsis ends and antisepsis begins, for asepsis is usually 
attained by an antecedent antisepsis. 

Undoubtedly the greatest of all antiseptics and germ- 
icides is health. It is only when the natural and nor- 
mal efficiency is vitiated that Nature becomes dependent 
upon Art. The healthy tissues of the human body 
neither harbor infectious organisms nor favor or aid 
their subsequent development when introduced. Indeed 
there cannot now be the slightest doubt but that the 
highest type of histologic vitality, which we commonly 
term health, is highly prejudicial to the action of path- 
ogenic bacteria. Furthermore when such have been in- 
troduced within the system, either by accident or de- 
sign, they are quickly destroyed either in the circula- 



84 

tion or tissues or else discharged through the various 
emunctory channels. Cunningham and others have 
proven that bacteria are frequently destroyed in the 
blood; Vaughan too has demonstrated the germicidal 
power of the nuclein of blood-serum. Wyssokowicz 
claimed that those organisms which are not destroyed 
rapidly in the blood are deposited materially in the tis- 
sues, just as is done in the case of particles of pigment. 
He introduced anthrax bacilli, in small qjiantities, into 
the blood of rabbits and found that they disappeared in 
twenty-four hours; he claimed however to have found 
them deposited in large numbers in the liver and the 
spleen. Cheyne, Ogston, Ribbert and others have 
proven the possibility of excretion of germs by the 
genitourinary tract, demonstrating their actual pres- 
ence in the kidneys and urine. It has also been proven 
that germs may be excreted by the mammary, and pos- 
sibly also the parotid glands. Indeed Passet and Lon- 
gard have shown that, in the case of mice at least, it was 
possible for cocci to be excreted by the conjunctival 
membranes. 

The medical literature of the past few years contains 
many references to the germicidal properties of blood- 
serum. May there not have been something of fact as 
well as fancy in the results ascribed to the old fashioned 
and almost obsolete practice of sending invalids with 
impaired vitality to abattoirs to partake freely of the 
warm, freshly drawn blood of recently slaughtered ani- 
mals? Not only has the blood-serum germicidal prop- 
erties but those of different animals vary in tbe intens- 



85 

ity of their powers. Thus the common domestic rat is 
highly resistant to the action of most bacteria which 
are pathogenic in their effects upon the hiy^g^ of" 
ganism. ^~^^ ^jso, ^di^.bmbai^e 

i^«iS0^gie*i6^^9l^^88'^v]i«^'' "Vviicu we consider how 
sKght a c^use may interrupt the normal operations of 
this delicate and highly complex machine called the 
human organism, how careful and watchful of its health 
we should be. These natural conditions and beneficient 
tendencies of the organism may be perverted by various 
causes such as injury, cold, inflammation, embolism, 
local or general depression of vitality, etc. For cen- 
turies men have climbed mountains, crossed oceans, 
bridged chasms, delved into the bowels of the earth, 
burned the midnight oil, courted death in a thousand 
forms in a vain and endless search for the illusive and 
delusive "Elixir of Life." All this time they labored 
in ignorance of the fact that the treasure sought lay 
constantly within their reach — nay, more— pulsing 
through their very beings. And yet— and yet— they 
found it not. 

For the most favorable development of germs and an 
exercise of vital activity certain physical conditions are 
necessary. Thus there must be (a) a certain degree of 
temperature, (b) a certain degree of moisture and (c) a 
suitable nutrient medium; a combination of these three 
conditions produces ideal surroundings for the develop- 
ment of micro-organic life. The growth and develop- 



86 

ment of germs can then be restrained physically by (a) 
elevation of temperature, (6) depression of temperatur^B, 
(c) absence of nutrient media, and {d) abseiKie of mois- 
ture— indeed they can be destroyed by sufficient ele 7a- 

are fd#i^^?«vi*d^ J^^^^^^^^ t^^ ^8i^tTife%^ 

be used as antiseptic agei^^i*§i4l^iFell«*t*^ftis, -JloW^ 
ever, are able to multiply at the freezing point (0^ C., 
32°F.), while others possess powers of proliferation at 
temperatures as high as 60^-70^ C, (140°-158^ F.)— we 
must remember in this connection that the freezing 
point is zero on the Centigrade scale in common scienUfic 
use and thirty-two degrees above zero on the Fahrenheit 
scale which is in commen t?ome5^tc use; and that the 
temperature at which water boils is one hundred degrees 
above zero on the Centigrade scale and two hundred and 
twelve degrees above zero on the Fahrenheit scale. The 
temperature favorable for the growth of most bacteria 
is 20^-40^ C, {68°-104° F.), but as a rule most parasitic 
species require a temperature of 35^-40° C. (95'^-104°F.), 
that is about the normal bodily temperature. In very 
high elevations of bodily temperature, if the blood be 
not altered, its germicidal power is increased owing to 
the inhibiting influence of elevated temperature; this 
advantage is inappreciable however because of the con- 
comitant depressed vitality of the body itself. Let us 
proceed then to a consideration of the virtue of physi- 
cal agents as antiseptics. , 

Cold. — The weight of experimental evidence goes to 
show that low temperatures do not usually kill bacteria, 



87 

although elevated temperatures do. Frisch (ISV?) ex- 
posed various cultures to a temperatur9 of 87^ C. bdow 
the freezing point — he obtained this exceeding low tem- 
perature by the evaporation of liquefied carbon di-oxid. 
Even after exposure to such a degree of cold he found 
that micrococci and bacteria multiplied abundantly 
when again placed under favorable conditions. Prud- 
den found that some species resisted low temperature 
while others did not. He based this latter conclusion 
upon the fact that some bacteria died, although he did 
not clearly prove such to be the result of the low tem- 
perature. As Sternberg aptly says, there would proba- 
bly have been a similar diminution in the cultures, more 
especially if old, owing to an exhaustion of pabulum; 
this of course might be independent of freezing for 
bacteria, like higher plants, die in time — indeed contin- 
ued vitality depends upon continued reproduction. 
Pnidden also found that repeated freezing and thawing 
was more fatal to some forms, such as the typhoid ba- 
cillus. Cadeac and Malet kept portions of a tuberculous 
lung frozen for four months; at the end of that time the 
injection of even a small quantity into guinea-pigs, was 
capable of producing tuberculosis in the animal so inoc- 
ulated and infected. 

Moist Heat. — The burden of experimental evidence 
seems to indicate that the thermal death point of bac- 
teria is comparatively low when subjected to the influ- 
ence of moist heat. Indeed a large number of patho* 
genie organisms are killed by exposure to temperatures 
of 55°-60° C. (131^-140° F.) for ten minutes; some are 



88 

killed at even slightly lower temperatures and by extend- 
ing the time of exposure it is exceedingly probable that 
somewhat lower temperatures still may effect the same 
result. Non-pathogenic bacteria as a rule require higher 
temperatures, such as 58^-65° C. (136 4°~149^ F.), and 
some even higher still to effect their destruction. Glo- 
big has obtained several species, from the soil, which 
grew at 50^-70° C. (122^-158° F.), while Miquel (1881) 
found a motionless bacillus in the water of the Seine 
which grew luxuriantly in bouillon at eO^-VO^ C. 
(156.2^-158° F.). 

The resistant powers of spores are, as a rule, greater 
than those of germs themselves; however, these resist- 
ant powers vary in strength among the various species. 
Even the spores of all known pathogenic bacteria are 
quickly destroyed by exposures (even though short, 
Sternberg says that five minutes is fully sufficient) to a 
temperature of 100° C. (212° F.), namely that at which 
water boils. The spores of the Bacillus anthracis^ the 
most resistant and tolerant of all the commoner patho 
genie organisms, are killed in four minutes by exposure 
to moist heat at 100° C. (212° F.). The results ob- 
tained by \ ersin and Sternberg seem to indicate that 
the spores Bacillus tuberculosis are destroyed by an ex- 
posure of ten minutes to a temperature of 70° C. 
(158° F.), although Voelsh claims that a temperature as 
high as 100° C. (212° F.) is insufficient for this. We may 
however reasonably and certainly rely upon the fact 
that exposure to moist heat at the boiling point (100° 
C. or 212° F.) is suflBcient to destroy all pathogenic 



89 

germs and spores in a few minutes. Sonle non-patho- 
genic germs and spores resist this temperature but be- 
ing non-pathogenic in character (that is, incapable of 
causing disease) the fact possesses little practical im- 
portance to the physician and surgeon. 

Dry Heat.— Koch and Wolffhuegel (1881) fully de 
monstrated that when micro-organisms are exposed, in 
a dessicated condition, to the influence of dry heated 
air a higher degree of temperature is required for their 
destruction than when they are moist, or exposed to the 
action of hot water or moist steam. These deductions 
were reached as the direct result of experiments made 
with a large number of pathogenic and non pathogenic 
species. 

Exposure for an hour and a half to a temperature of 
78^-123° C. (lYS. 4^-253 4° F ), and for one hour to a 
temperature above 100° C, (212° F.) failed, in the case 
of dry heat, to kill various non-pathogenic germs but 
did destroy the bacteria of mouse septicemic and rabbit 
septicemia. A temperature of 120°-128° C. (248°- 
262.4° F.) and an exposure of an hour and a half was 
required to insure the destruction of all species treated 
in the absence of spores. The spores of Bacillus anthra- 
CIS 2iX\A Bacillus siibtilis resisted this temperature, requir 
ing a temperature of 140° C. (284° F.), and an exposure 
of three hours to effect their destruction But this 
temperature is decidedly injurious to bedding, clothing, 
and most of the commoner domestic objects requirfng 
disinfection. Since the specific germs of diphtheria, 
typhoid fever, erysipelas and cholera do not form 



90 

spores, objects infected by these diseases may be dis- 
infected by dry heat at a temperature of 120° C. 
(248° F.) and an exposure of two or three hours. 

Dry heat is not only less active than moist heat but 
is also less penetrating, especially so in the case of 
folded blankets and other articles fashioned of poor 
conductors of caloric. Koch and Wolff huegel demon- 
strated this by placing registering thermometers within 
folded blankets and various packages. After exposure 
for three hours in a hot air oven to a temperature of 
133°C. (27l.4°F.) the thermometers showed that a suffi- 
cient temperature to kill bacteria had not been attained 
internally. Rohe conducted similar experiments, sub- 
jecting rolls of blankets to a temperature of 280°F. 
(137. 8°C.) for three hours; he found that they were but 
very slightly affected in their interior. 

Hence it seems that moist heat is much more effective 
as a germicidal agent than dry heat. In the case of 
moist heat the liquid pierces or penetrates mechanically 
thus carrying the heat to every portion; it must be evi- 
dent then that to secure thorough disinfection of cloth- 
ing, blankets, sheets, etc., boiling is necessary. 

Dessication. — Cultures in the moist condition may 
retain their vitality for a considerable length of time. 
Paul says that the typhoid bacillus has retained its vi- 
tality more than six months. Dessication is however 
quickly fatal to some pathogenic bacteria, such as the 
cholera spirillum which Paul says perishes after dessica- 
tion for one half hour at the ordinary temperature. 
The typhoid bacillus withstands this treatment for eight 



91 

or ten weeks, the bacillus of diptheria four or five months 
and the bacillus of tuberculosis five months. Spores 
however retain their vitality, even in a dessicated condi- 
tion, for a great length of time. 

Light. — Downes and Blunt (1811), in a report to the 
Royal Society of London, first called attention to the 
fact that light has an injurious effect upon bacterial life 
— indeed they even claimed that cultures might be ster- 
ilized by exposure to direct sunlight. Tyndall verified 
these claims to some extent by experiments showing that 
development is restrained at least by direct exposure. 
This does not seem altogether improbable when we re- 
member that many of the bacteria are lower forms of 
vegetable life devoid of chlorophyll and on this account 
would thrive better in absence of direct sunlight. Then 
too we know that light undoubtedly has certain definite 
actinic and chemic powers. 

Gaillard's experiments seem to conclusively prove 
the germicidal power of sunlight in the presence of 
oxygen. Geisler thinks that such effects are partially 
due to the action on the gelatin culture media and Koch 
confirms this result with his experiments with the tub- 
ercle bacillus. 

Sternberg says that exposure to sunlight is one of the 
most potent and the cheapest of agents for the destruc- 
tion of pathogenic bacteria and is a practical and valua- 
ble hygienic measure. 

Electricity.-— Attempts have been made recently to 
utilize this force for the destruction of germ life. Re- 
cent experiments make it seem doubtful that the elec • 



92 

tricity acts directly; if so, strong currents and moder- 
ately long exposures are essential. It is, or seems rea- 
sonably certain, that the chief virtue of electricity lies in 
the virtue of the products of its electrolytic action. For 
instance the decomposition of aqueous media would 
yield nascent oxygen and hydrogen, the former of which 
possesses undoubted antiseptic value. 

The number of antiseptic substances proposed and 
recommended by various authors and experimenters is 
considerable and is furthermore constantly increasing 
without cessation. It is important then that the physi- 
cian and surgeon should be moderately familiar with 
these substances, or their comparative values at least. 
These different products do not act uniformly in their 
resistance to different pathogenic micro-organisms; one 
agent may be exceedingly active against one species 
and inert towards other. Then again spores are often 
and indeed usually more resistant than the parent germ. 
Not only do becteria vary in their resistive power to 
the action of antiseptic substances but the activity and 
value of the latter may be influenced by various sur- 
rounding conditions. Chief among these are the nature 
and quantity of the material with which the bacteria 
are associated. Some disinfectants act by an oxidation 
of the offending entities and a mutual destruction of the 
germ and germicide results, as is the case with potassic 
permanganate. But this substance oxidizes organic 
matter of all kinds; hence, if organic matter exists as- 
sociated in quantity with germs the value of the ger- 
micide may be impaired because it may oxidize the or- 



93 

ganic matter and be itself destroyed before the bacteria 
are affected. Then again we must consider the chemi- 
cal nature of the substances thus associated with bac- 
teria. For example, silver nitrate is a very efficient 
germicide and antiseptic but if used to disinfect urine 
its germicidal efficiency would be highly impaired if 
not entirely counteracted by the action of the sodic 
chlorid of the urine upon the silver salt, the latter be 
ing precipitated as an insoluble and comparatively inert 
argentic chlorid, thus— 

Ag NOs+Na CI=Ag Ci+Na NOg- 

Moreover the presence of albumin may inhibit the 
action of mercuric chlorid (Hg CI 2) and other metallic 
salts. Van Ermengem states that the spirilla of cholera 
are destroyed in bouillon in one half hour by mercuric 
chlorid in the proportion of 1:60,000; while m Wooc7- 
seriim a proportion of 1:800 was required to effect the 
same result that is, a solution nearly seventy- five times 
as strong in the latter case as in the former. Why is 
this? Bouillon, as has been conclusively proven, con- 
sists chiefly of the extractive salts of beef, it contains 
little or no albumin, being analogous in chemical compo- 
sition to urine. Blood-serum is rich in albumenoids — 
the inference is obvious. 

Some agents are rapid in action, others extremely 
slow. Then again different species of bacteria require 
different exposures, some of short duration while others 
require a lengthy exposure; this is on account of the 
varying resistive powers. Nissen found that a solution 
of "chloride of lime" (the hypochlorite is what is really 



94 

meant) contaiDing .12% destroyed anthrax bacilli in one 
minute and the cholera spirilla and typhoid bacilli in 
five minutes. Other agents might require several hours. 
As a rule the stronger the solution the shorter the time 
of exposure required and vice versa. 

The temperature at which an exposure is made may 
directly affect the result. Very high temperatures in- 
hibit vital activity (and indeed may even destroy), 
hence under such conditions of restraint of resistive 
power we would naturally expect to find the germ espe- 
cially susceptible to antiseptics. 

The number of antiseptic substances is legion and as 
no definite and rational method for grouping them has 
as yet been devised, perhaps an alphabetic arrangement 
may prove most convenient for their individual consi- 
deration. 

AcETANiLiD, (Anttfebrtn), also termed Phenyl 
acetamid. The drug is chemically an anilin in which 
one atom of hydrogen has been displaced or replaced 
by the compound radical acetyl, thus: NHCeH5C2H30. 
It is a white, crystalline substance when pure, occurring 
in brilliant rhombic plates. It is usually prepared by 
the action of strong acetic acid upon anilin and by 
prolonged contact with hydrochloric acid is resolved 
into its constituents. Acetanilid is insoluble m water 
at ordinary temperatures but is readily soluble in chloro- 
form and ether; it is also somewhat soluble in alcohol, 
in the proportion of 1:3.5. It is chiefly used as an 
antipyretic but has been recommended as a local anti- 
septic. Its abuse gives rise to toxic symptoms. 



95 

Acetic Acid. — Pure acetic acid is a colorless liquid, 
having a peculiar pungent odor like that of strong vin- 
egar (which usually contains 4-6% of acetic acid), free 
from empyreuma and possessing an intensely acid taste. 
It is, in concentrated conditions, somewhat escharotic 
and corrosive. It is the second member of the group 
of so called ''fatty acids", resulting from the direct ox- 
idation of ethyl aldehyd or the ultimate oxidation of 
ethyl alcohol. Its chemical formula is HC2H3O2 or 
CH3 COOH. The acid as usually sold contains about 
thirty-six per cent of monohydrated acetic acid; abso- 
lute acetic acid is a crystalline solid somewhat analo- 
gous to ice in appearance and hence termed glacial 
acetic acid. In a concentrated form it is a corrosive 
poison. 

Koch found that 5% failed to kill anthrax spores 
even after five days exposure* Abbott found that the 
same spores resisted the action of 50% glacial acetic 
acid, even after an exposure of two hours — -indeed the 
spores of the anthrax bacillus seem to possess peculiar 
resistant power to the action of the acid. Kitasato 
however found that 3% would kill typhoid bacilli in 
five hours while 2% effected the same result in the same 
time with the spirilla of cholera. 

M. Haschimodo has reported from Paris that a vine- 
gar containing 2:2-3.3% of acetic acid saturated with a 
pure culture of the spirilla of cholera can, after an in- 
terval of fifteen minutes be inoculated into animals 
without danger— or even eaten with impunity by human 
heinous. 



96 

In i8'74 Klein made the statement that corrosive 
sublimate had no more germicidal value than vinegar. 
It is interesting to note that McClintock, in testing the 
truth of this statement, found that vinegar containing 
6:3-7% of acetic acid prevented the growth of micro- 
organisms as efectually as a \:\(iOO solution of corrosive 
sublimate These results completely verify Klein's 
statement. 

Crude acetic acid (pyroligneous acid), sometimes 
called **wood vinegar," is the crude product obtained 
when wood is subjected to destructive distillation. It 
IS a dark-brown liquid, almost black, the color depend- 
ing upon the amount of tar contained; it possesses a 
characteristic, penetrating, smoky odor very like that of 
burnt wood. The tar present is ren<lered soluble by the 
acetic acid — indeed acetic acid has also the power of 
effecting a partial solution, at least, of albuminous sub- 
stances; the presence of this tar, no doubt, adds much 
to the antiseptic qualities of the liquid. Some attention 
has been paid to this substance during the past year; 
its accessibility, its cheapness and other properties 
would make it very desirable if subsequent researches 
and experiences can indubitably prove that it has de- 
cided antiseptic qualities. During the past year it has 
been constantly used in various morgues and hospitals 
and, 2i9> Squibb says, has worked admirably. 

Acetone. — Produced by the dry distillation of an 
acetate, such as calcic acetate; its chemical formula is 
(0113)200. Koch has demonstrated that anthrax spores 
grow freely after two days exposure to the action of 



97 

acetone and that tbey are not destroyed by five days ex- 
posure, although their action is somewhat enfeebled. 

Alcohol. — Chemically the hydroxid of ethyl (the 
second member of the radicals of the marsh-gas series), 
its chemical formula being C2H5OH. The properties of 
this substance are too well known to need description. 
It was one of the first antiseptics used, though now 
almost entirely discarded. It was advocated in a 
pamphlet by Bataille (1859) and adopted by Nelaton 
(1863) and also by Le Fort. Schill and Fischer demon- 
strated that tuberculous sputum had its infectious 
nature destroyed by alcohol, but that five volumes of 
absolute alcohol were necessary to destroy the bacilli, 
equal volumes being inefficient. Pare cultures of the 
bacillus were completely sterilized by five minutes ex- 
posure to the action of absolute alcoho . Koch found, - 
however, that even an exposure of one hundred and ten 
days had no effect upon anthrax spores. 

Alum. — The alums are hydrated double sulphates of 
aluminum and some other positive radical — more com- 
monly either potassium or ammonium, thus: K2AI2 4 
(SO,) .24H.,0 or (NH,)2 AI.2 4 (SO,) .24H2O. Miquel has 
determined that while alum is not germicidal it is anti- 
septic and that a proportion of 1:222 is sufficient to 
restrain putrefactive decomposition in bouillon. 

Aluminic Acetate.— A1 (0311302)3. Kuhn has de- 
termined that it is antiseptic in action in the proportion 
of 1:5,250 while De la Croix places its antiseptic power 
atl:6,31Q. 

Aluminic Chlortd. — AlClg. Miquel has deter- 



98 

mined that this substance is antiseptic in the proportion 
of 1:714. 

Alumnol. — ^This new aspirant is an aluminum salt of 
naphthol-sulphonic acid. It is a reddish white, non- 
hygroscopic powder, darkening in color by age or ex- 
posure. It has but recently been introduced to the 
notice of the profession; this was done at the late 
International Congress of Dermatologists in Vienna. 
The drug is readily soluble in cold water, much more so 
in hot water, less so in glycerin and alcohol and insolu- 
ble in ether. It has an acid reaction and precipitates 
gelatin or albumin, this precipitate being soluble in ex- 
cess of gelatin or albumin and thus allowing penetration 
of the drug within the tissues by virtue of this peculiar 
property. It is closely allied to Sozal and Sozo iodol 
but is much more astringent than either. 

Eraud, of Paris, has u^^ed the drug extensively and 
declares that it neither irritates nor gives pain. Spen- 
gler found that it is comparatively free from poisonous 
properties but that when large quantities were intro- 
duced beneath the skin or within the stomach the kid- 
neys were apparently affected — although Spengler does 
not state it, this is probably due to renal elimination. 
Indeed Drs. G. B. Wood and A. Stille hold that other 
salts of aluminum, analogous to alumnol, are found in 
the urine of persons taking them. 

The drug has not, as yet, been largely used in this 
country. Blount and Delavan, of New York City, re- 
ported favorable results from its use at the late Pan- 
American Medical Congress. Dr. Delavan says how- 



99 

ever that be could not put it on as high a plane of use- 
fulness as was claimed for it. Its high price (costing 
four times as much in this country as in Germany) algo 
stands in the way of its general use. Good reports have 
been given of its use in gynecology and otology, but it 
is probably too early as yet to put a proper estimate 
upon its value. 

AmmcTnia. — Occurs as a gas (NH3) and in aqueous 
solution (NH^OH, ammonic hydroxid, ammonic hydrate 
and**ammonia water"). Kitasato found that .3% would 
kill the typhoid bacilli and the cholera spirilla after an 
exposure of live hours. 

Ammonic Carbonate. — (NH4)2C03. Kitasato found 
that a solution of 1:125 restrained the development 
while 1:100 killed the typhoid bacillus in five hours. A 
strength of 1:77 was required to kill cholera spirilla in 
the same time. 

Ammonic Chlorid.— NH4CI. Koch found that a 5% 
solution did not kill anthrax spores even after twenty- 
live days exposure. Indeed the substance has no germ- 
icidal power, but Miquel gives it antiseptic power in the 
proportion of 1:9. 

Ammonic Fluo- Silicate. — (NH4)jSiFft. Strongly germ- 
icidal and antiseptic. Faktor demonstrated that a 2% 
solution killed anthrax spores after from one-quarter to 
three-quarters of an hour exposure. A solution of 1:1- 
000 prevented the growth of the bacilli of anthrax and 
typhoid fever, even in nutrient gelatin media. 

Ammonic Sulphate. — (NH4)2S04. Koch found that a 
4% solution required five days to kill anthrax spores. 



100 

Miqud found the substance antiseptic in the proportion 
of 1:4, 

Anilin Dyes. — Those U'^ed as antiseptics are chiefly 
rosanilin, methylene blue, methyl violet and methyl yel- 
low, the two latter being sold by Merck as a patented 
preparation under the name of Pyoktanin, These sub- 
stances are all intense coloring agents, even in minute 
quantities. Sternberg says that recent researches indi- 
cate that these agents possess decided germicidal pow- 
ers, even in dilute solution. Boer found that the vari- 
ety known as ^^malachite green" was even more effica- 
cious than methyl violet, yet gave them both a germici- 
dal value far above that of mecuric chlorid. Roswell 
Park after a most exhaustive series of experiments 
denies utterly all such claims to efficiency. He says: 
'*! have been led to detail my experiments with the 
material not merely as illustrative of a method, but be- 
cause numerous articles have recently appeared with re- 
ference to it, in some of which the writers appear to 
have allowed their verdicts to be influenced by what the 
manufactures have claimed for it, rather than by any- 
thing like a scientific test of its genuine value. 

I would not wish to be understood as inveighing 
against a certain well-known value which most all of 
these anilin preparations have in common. In 1872, Dr. 
Chas. Curtman, of St. Louis, made known the fact that 
they possess antiseptic properties, and common experi- 
ence confirmed his statement. Stilling has gone so much 
further as to assert that they are absolutely non-poisonous, 
a statement which is far from justified by facts. ^ * 



101 

On the whole, then, it has but few qualities by which 
we are to commend it above numerous other drugs of 
its general class, while in all that may answer to the 
more scrupulous demands of aseptic surgery it has 
proved in my hands — as in those of others who have 
tested it from the purely clinical standpoint— -disappoint- 
ing." (See Pyoktanin and Methylene blue), 

Anilin Oil. — Riedlin says that anilin water, in tbe 
strength of 1:5, has the power of preventing the devel- 
opment of bacteria even in nutrient gelatin media. 

Anisic Acid. — CgH^OCHgCOOH. This substance is 
a constituent of the oils of anise and fennel and is an 
isomer of methyl salicylic acid, which latter is closely 
similar to synthetic oil of wintergreen (a compound 
ether, or ester, namely methyl saliclyate). The acid 
occurs in the form of colorless prisms which are insolu- 
ble in water but are freely soluble in hot and cold alco- 
hol. The drug possesses antipyretic as well as antisep- 
tic properties; it has been used in the treatment of 
wounds. 

Annidalin. — This substance is frequently confounded 
with Aristol which it closely resembles chemically and 
physically. Annidalin is dithymol tri-iodid while aris- 
tol is the di'Wdid, It is a reddish brown powder in 
which light and heat cause the liberation of iodin. It 
is insoluble in water, slightly soluble in alcohol and 
readily soluble in ether and chloroform. Cerna says 
that aristol is only slightly soluble in chloroform; if this 
is so it would be a ready means of distinction between 
annidalin and aristol, since the former is freely soluble 



102 

in chloroform. But the manufacturers of aristol claim 
that it is freely soluble in chloroform. 

Annidalin is used chiefly as a local antiseptic and 
dusting power, probably owing its chief virtue to the 
gradual decomposition and consequent liberation of 
iodin. It is proposed as a substitute for iodoform, but 
like the latter is practically devoid of active germicidal 
properties. 

Anthrarobin.^ — Also termed Desozy alizarin. This 
substance, a derivative of phenol and allied to chryso- 
phanic acid, is obtained from alizaririy the crystalline 
principle of the common madder-plant. It is a yellow- 
ish powder readily soluble in alcohol, glycerin and 
dilute alkaline solutions; sparingly soluble in ether and 
chloroform and insoluble in water or acids. It is used 
chiefly as an anti-parasitic in dermatology and has been 
of special value, it is claimed, in psoriasis, ptyriasis 
versicolor and also herpes; it is usually used in the form 
of an ointment. 

Antifebrin, (see Acetanilid), 

Antipyrin, (Analgesin), — Also called Phenozon, 
MethoziUj Phenyl di rmthyl pyrazoloyi^ Dimethyl oxy- 
quimzine and Dehydro di-rnethy I phenyl pyrazine. It is 
a derivative of coal tar, its chemical formula being 
CuHiaNaO. Antipyrin is a white or reddish white, 
crystalline, odorless powder of somewhat bitter taste 
and used chiefly as an antipyretic and analgesic. It is 
readily soluble in cold water, rectified spirits, and chloro- 
form — also in ether in the proportion of 1:50. It has 
been demonstrated that the drug also possesses antisep- 



103 



tic properties. Experiments seem to confirm the slate 
ment that, in vitro, it has the prower of destroying the 
diphtheritic bacillus in forty-eight hours. 

Antisepsin (Asepsin). — Called also Para mono- 
brom phenyl' acetamid and Para-mono broniaxetanilid 
and having the chemical formula CgH^BrNHCaHgO. 
It occurs in odorless, tasteless crystals which are 
soluble in alcohol and ether, slightly so in gly- 
cerin and insoluble in water. It has been used 
in typhoid fever, pneumonia and phthisis and 
also locally in wounds and hemorrhoids. Has attracted 
but little attention. 

Antiseptin. — Called also Zinc borothymo4odid 
and lodo boro thymolate of zinc. It is not however 
a definite chemical compound, as either of these names 
would indicate, but a mixture of at least four definite 
and distinct chemical compounds. Its composition has 
been given by Squibb, Goldmann and Cerna as follows: 





SQUIBB. 


GOLDMANN. 


CRRNA. 


Zinc Sulphate, 


85 


85 


80 


Zinc iodid. 


2i 


2\ 


— 


Thymol, 


2i 


2h 


2 


Boric acid, 


10 


10 


10 



It is apparently but little used and noticed and indeed 
can hardly be said to be in general use now. 

Antisepiol. — This substance chemically is the iodo- 
Bulphate of cinchonin. It is a reddish-brown powder 
which is soluble in water, alcohol and chloroform. It is 
chiefly suggested as a substitute for iodoform. 

Arbtjtin. — CisHjeO.. This substance is a glucoside, 



104 

found (about 3.5%) in the leaves of the common bear- 
berry {Arctostaphylos Uva ursi) and in other plants, 
especially the members of the natural order Ericaceoe, 
It occurs in long, colorless and brilliant silky needles or 
bunches of such needles which are sparingly soluble in 
cold water, slightly so in ether and readily soluble in 
hot water and alcohol. The crystals have the formula 
(Ci2Hie07)2 .H2O, but lose this water of crystallization 
at the boiling point (100® C); they possess a bitter 
taste and a neutral reaction. This substance is chiefly 
employed in affections of the genito urinary tract and is 
said to be a most valuable antiseptic in this respect. 
. This effect is probably not due to direct action of the 
drug itself but to the hydroquinoiu (CeHeOg) which is 
set free in the organism^ When arbutin is boiled with 
dilute sulphuric acid or subjected to the action of emul- 
sin or another ferment contained in the bearberry it is 
converted into hydroquinoiie and glucose. It has 
been proven by Von Mering and Steffen that the dis- 
coloration of the urine which ensues upon the adminis- 
tration of arbutin is due to the breaking up of the ar- 
butin in the body into glucose and hydroquinone. This 
change probably takes place in the kidneys, as arbutin is 
free from toxic properties while, as Brieger, has demon- 
strated, hydroquinone is poisonous; Forster has shown 
that the latter is a powerful disinfectant and anti- 
ferment. It is stated that a one per cent solution will 
arrest putrefaction and alcoholic fermentation while 
one half per cent is sufficient to arrest butyric fermen- 
tation. 



105 

Wher administered internally usually about lb grains 
per diem, in divided doses, are given. 

Aristol.— Sometimes erroneously termed Annidaliyi. 
Chemically it is di-thymol di-iodid and consists of two 
molecules of thymol (CioHigOH) in which two atoms of 
hydrogen and two radicals of hydroxyl (OH) have been 
displaced by two radicals of iodoxyl (01). The empiri- 
cal formula then would be C22H,4 (01)2- It is a reddish- 
brown powder with an aromatic odor and is produced 
by the action of an aqueous solution of iodin in 
potassic iodid upon an aqueous solution of thymol in 
the presence of potassic hydroxtd. It is readily soluble 
in ether, chloroform, collodion and traumaticin; slight- 
ly so in alcohol, and insoluble in water, glycerin and 
alkalies. It has been largely used as a local antiseptic, 
in the form of powder, solution and ointment, in many 
conditions — especially as a succedaneum for iodoform, 
which is unbearable on account of its intolerable and 
disagreeable odor. 

Arsenous Acid. — This is the substance formerly 
termed "arsenious acid" but which the last edition of 
the Pharmacopeia changes to its present form by elimi- 
nation of the letter '*i". Arsenous acid properly so- 
called has the chemical formula Hg AsOg, but its anhy- 
drid (Asj O^) is so frequently called by this name as to 
give rise to some confusion. The solution of the anhy- 
drid in water gives a dilute solution. of the acid how- 
ever. Koch found that 10% destroyed the vitality of 
anthrax spores only after an exposure lasting ten days, 
no such result being produced in six days. Miquel has 



106 

determined that it is antiseptic in the proportion of 
1.166- 

AsAPROL. — Chemically this substance is Calcium beta' 
naphthol alpha-mono sulphonate and has the formula Ca 
(OH.CioH6S03)23H^O. It is a white scaly powder ob- 
tained by the action of heated sulphuric acid upon beta- 
naphthol and then forming the calcium salt by combina- 
tion with the resulting acid. It is readily soluble in 
water and alcohol. 

It is recommended as an antiseptic in solutions with 
a strength of 5%. It destroys cholera spirilla in strong 
solutions and prevents the growth of microbes in weaker 
solutions and is quite popular in France but has gained 
little or no foothold in this country. 

AsEPTiN.— Is said to be an empirical mixture of boric 
acid, borax and alum. Is seldom heard of, clinical 
literature on the subject being somewhat scarce. 

AsEPTOL. — Also called Or tho phenol ^ SulphO'Carholic 
acid^ Sul phonic acid^ Ortho phenyl sulphonic aaW and 
Sozolic acid. It is usually found in the form of small, 
deliquescent and crystalline needles or else, more 
frequently, as a heavy, reddish, volatile liquid nearly 
one and a half times as heavy as water and of a syrupy 
consistency. It has an astringent taste and an odor 
strongly resembling that of carbolic acid. It is ob- 
tained by the chemical action of equal parts of concen- 
trated sulphuric acid upon carbolic acid in the cold; 
its chemical formula is CgH^OHSOgOH. It is freely 
soluble in water, alcohol and glycerin. It is used inter- 
nally in the form of a lemonade and locally in solutions 
of l^to 10%. 



107 

According to Hueppe a 10% aqueous solution kills 
anthrax spores in ten minutes, but a 3-5% solution is a 
reliable disinfectant in the absence of spores. Squibb 
says that **lt has not supplanted carbolic acid so far, 
however, although it has now had several years to ful- 
fill the original expectation." In the last number of his 
^^Ephemeris" he says that Aseptol ''has not fulfilled 
its promised mission of supplanting carbolic acid and 
may now be considered on the retired list.'* 

Baric Chlorid. — BaClg. The salts of barium have 
practically little or no use in medicine. Miquel has 
determined however that the chlorid has antiseptic 
properties in the proportion of 1:10. 

Benzkne (Benzol). — CgHg. A colorless volatile 
liquid, slightly lighter than water and obtained by the 
distillation of coal tar. Benzene or Benzol is a definite 
chemical compound and is not to be confounded with the 
commercial "benzine" used for the removal of grease, 
etc.; this latter substance is a complex mixture of the 
hydrocarbons of the marsh gas series and is not a defin- 
ite chemical compound but a mixture of compounds. 
Benzol has been used of late in the treatment of influ- 
enza. It is also used as a parasiticide; Sneguersky and 
others have reported the successful treatment of scabies 
(itch) by inunctions of benzol alone, or mixed with 
equal parts of fat. Redness of the skin is produced, by 
brisk friction with a thick cloth, before the application 
of the drug. Sneguersky finds that the pure article is 
best adapted for the treatment of the parasitic condition 
uncomplicated, but when accompanied by an eczema- 



108 

tous condition the best results are obtained when the 
benzol is conjoined with an emollient fat. 

Koch made experiments with a view to deciding the 
germicidal power of this substance; he found that 
twenty days exposure was insufficient to kill anthrax 
spores. 

Benzoic Acid,— HC.HsO^ or CgHsCOOH. This sub- 
stance occurs naturally as a constituent of gum benzoin, 
which is the concrete juice of a tree indigenous to Peru. 
Benzoic acid may be prepared by the sublimation of this 
gum or it may be prepared artificially from naphthalene. 
It usually occurs in the form of white feathery crystals 
of a silky lustre and a fragrant aromatic odor due to 
the presence of a volatile oil-r-the pure acid is free from 
odor. It melts and volatilizes without decomposition 
at 250°. It is but slightly soluble in cold water, more 
so in warm or hot water and freely so in ether, alcohol, 
fixed oils and alkaline solutions. Benzoic acid is widely 
distributed throughout the vegetable kingdom, consti- 
tuting the peculiar principle of all true balsams and is 
occasionally present in the urine of herbivora. In 1872 
Dougall announced that benzoic acid is one of the most 
active of antiseptic drugs; this statement caused experi- 
mentation and investigation on the part of Bucholtz, 
Grube, Fleck and Salkowski, they were all unanimous 
in ascribing to benzoic acid a first rank as regards its 
efficiency in destroying bacteria and preventing putre- 
faction. In the majority of these investigations benzoic 
acid was found to be much more efficient than salicylic 
acid. Bucholtz found that while .02% of benzoic acid 



109 

had a very perceptible effect upon the development of 
bacteria their growth was entirely inhibited by .1%; he 
found also that sodic benzoate was no less effective 
than the acid itself. His experience with .1% is very 
similar to the result obtained by Miquel. The acid has 
the property of preventing the decomposition of animal 
fats and inhibiting the development of rancidity; it is 
much used, because of this property, as an ingredient 
of various ointments. 

More recent and complete bacteriological investiga- 
tions as to the action of benzoic acid determine, as 
Sternberg says, the entire absence of germicidal power 
although it possesses antiseptic properties. Miquel has 
determined that the substance is antiseptic in the pro- 
portion of 1:909, a result strongly similar to that of 
Bucholtz with a preparation containing .1% of the acid. 
The substance and its derivatives have been used in sev- 
eral of the zymotic diseases with asserted good results. 

Benzo-Naphthol. — Chemically this substance is the 
benzoate of beta, naphthol and has the chemical formula 
CioH^O.CtHsO. It occurs in small, dull, white, odorless 
and tasteless crystals which are insoluble in water and 
ether at ordinary temperatures and freely soluble in 
alcohol especially when hot. It is said to break up in 
the intestinal tract into its constituents, as does salol. 
It is generally used as an antiseptic and is said to have 
afforded good results in the treatment of both simple 
and tuberculous enteritis. Benzo-naphthol possesses 
slight toxic properties. It has never been claimed by 
the most conservative that it will act beneficially in any 



no 



but mild cases, best in mild chronic cases, especially 
when treatment has been instituted sufficiently early — 
that is, before the micro organisms have multiplied to 
any great extent or have exhibited much activity by be- 
coming firmly established in surroundings favorable to 
their rapid multiplication. 

It is best administered in wafers in doses of 4 to 8 
grains. 

Bknzo-Phbnoneide. — This substance is a new com- 
pound, is obtained from anilin dye and is, chemically, 
TetramethylO'diapsidobenzo pheno7iei^e. It has been 
accredited virtue as a microbicide when locally applied. 
It is but little used or heard of, although it is said to 
have given favorable results in the treatment of various 
affections of the optic tract. 

Benzoyl • Eugenol. — CeHg .C3H5 (OCHs) COS^^Yi^. 
This substance is a derivative of eugenol and benzoic 
acid; it occurs in the form of acicular, colorless and 
odorless crystals which are soluble in alcohol, chloro- 
form, ether and acetone but insoluble in water. But 
little is definitely known about this substance as yet, 
except that it is being employed experimentally in the 
treatment of tuberculous conditions. 

Benzoyl-Guaiacol (Benzosol). — This substance is 
the benzoate of guaiacol and is analogous to Benzoyl- 
eugenol. It contains fifty-four per cent of guaiacol and 
is represented by the chemical formula CeH^OCHg 
OCOCfiHg. Benzosol occurs in small colorless, odorless 
and almost tasteless crystals, having a slightly aromatic 
flavor. It is practically insoluble in water but soluble 



Ill 

freely in hot alcohol, ether and chloroform. The ali- 
mentary juices split up the compound into its constitu 
ents and liberates the effective guaiacol under conditions 
that avoid the unpleasant taste and that reduce the 
local irritation which results when guaiacol itself is 
used. It has been used successfully, it is said, wherever 
creosote or guaiacol are applicable; it is said to be es- 
pecially useful as an antiseptic in intestinal disorders 
and in phthisis pulmonalis. 

Benzoyl-guaiacol is best administered in chocolate 
pastilles with peppermint oil or sugar, or else in powder 
of doses of 3-12 grains. 

Betol. — Also known as Naphtalol^ Naphtosalol and 
SalinaphtoL Chemically it is a salicylic of beta-naph- 
thol, closely allied to salicylate of phenol {Salol), and 
is represented by the chemical formula C5H4OHCOOC10 
Hy. When pure the substance occurs as a crystalline, 
colorless, tasteless and odorless powder which is insolu- 
ble in water and glycerine, slightly soluble in alcohol and 
turpentine at the ordinary temperature and readily solu- 
ble in boiling alcohol, ether, benzene and linseed oil. 
Betol has been favorably used as an intestinal antisep- 
tic and also with advantage in vesical catarrh, cystitis 
and gonorrhea. 

Betol can be administered in pill or in emulsion in 
doses of 2-5 grains. For making bougies or supposi- 
tories it may be mixed with cacao-butter in the strength 
of 1:4. 

Borax. — ^This substance is the sodium salt of boric 
or boracic acid and is frequently, though most errone- 



112 

ously, termed "sodium borate" and ^'sodium bi-borate" 
—it is really the tetra borate although most others than 
chemists describe an entirely different body under this 
name. Its chemical formula is Na2B407 .lOHgO^ It 
may be considered as four molecules of boracic acid 
(HgBOs) in which only two of the hydrogen atoms have 
been displaced by two atoms of sodium, producing a 
chemical compound whose formula would be NajB^OT, 
the remaining ten atoms of hydrogen uniting with the 
remaining five atoms of oxygen to produce "water of 
crystallization." Or it may be considered as the sodium 
salt of tetra boric acid, whose chemical formula is 

H,BA. 

Borax occurs in colorless, transparent crystals but is 
also sold in the form of a white, non crystalline pow- 
der. It is soluble in cold water, freely soluble in boil- 
ing water or warm glycerin and insoluble in alcohol. 
When heated it puffs up like alum, losing its "water of 
crystallization." It possesses antiseptic properties, 
although, as Sternberg says, even a saturated solution 
of the substance has no germicidal power. Miquel has 
determined that it is antiseptic in the proportion 1:14. 

Boracic Acid (Boric Acid). — H3BO3. This substance 
occurs in glittering, scaly crystals; it is also found in 
natural solutions in volcanic regions, as in Nevada and 
California and the fameroles and so-ffiani of Tuscany. 
It is soluble in 26 parts of cold water and 3 parts oi 
warm or hot water, but is freely soluble in alcohol. 

As an antiseptic Lister considers it almost as efficient 
as carbolic acid. By reason of its insipidity, its entire 



113 

freedom from odor and irritating properties and the 
almost utter absence of toxic properties, as well as its 
cheapness, it is of great utility as an antiseptic, though 
possessing little or no germicidal power. It is highly 
praised as an antiseptic and deodorant, arresting putre- 
faction and fermentation — the Bacterium iermo seeming 
to exhibit special susceptibility to its action. 

In the experiments of Dr. Walb, a solution of 2% 
distinctly checked the putrefaction of a solution of 
fibrin, while 5% kept it fresh for nineteen days. Buch 
oltz found .75% sufficient to prevent the development 
of bacteria. The experiments of Sternberg seem to 
show, as he himself says, that boracic acid possesses 
considerable antiseptic power but no great germicidal 
power. Rosenthal demonstrated its power to check 
urinary fermentation in cystitis accompanied by ammo- 
niacal urine, even when administered internally — indeed 
Johnson has proven that it appears in the urine within 
ten minutes after its ingestion. The experiments of 
Kitasato show that a 2.7% solution had the power of 
killing typhoid bacilli after an exposure of five hours 
and that a 1.5% solution killed cholera spirilla in a simi- 
lar length of time. Miquel places its antiseptic power 
as 1:143. 

By virtue of its freedom from irritating properties 
and its exceedingly low toxic power it is of great prac- 
tical value in the treatment of wounds, ulcers, abscesses, 
burns, inflammations of the throat and eye, and is espe* 
cially valuable for continuous irrigation either in ob- 
stetrical or surgical operations; these properties make 



114 

it also very useful in the local antiseptic treatment of 
the newly-born. 

Boracic acid may be administered internally in doses 
of 10-15 grams, from three to six times a day. 

Bromoform. — Also termed Tri-bromo-methanCy a 
compound analogous to chloroform and iodoform — this 
analogy is best seen by a comparison of the chemical 
formulae which are as follows: 

CHBrj CHCls CHI, 

It may be prepared by the action of bromin and 
potassic hydroxid upon methyl alcohol or by the action 
of sodic hypobromite upon acetone. Bromoform is a 
colorless^ clear, limpid liquid with an agreeable odor and 
a sweetish taste. Any coloration of the substance indi- 
cates its decomposition with a consequent liberation of 
bromin; such specimens should be rejected if intended 
for internal use. The liquid is quite heavy, being 
nearly three times as heavy as water and with a boiling 
point higher than that of the latter; it is soluble in 
alcohol and ether but insoluble in water. It possesses 
to a marked extent the antispasmodic, hypnotic and 
analgesic properties of the bromids (due no doubt to 
the bromin contained therein) but possesses also some 
antiseptic properties. Dr. S. Solis-Cohen reports favor- 
able results from its use in ozena and tuberculous as 
well as other ulcerations of the larynx. In England 
success is said to have followed the use of inhalations of 
bromoform in the treatment of diphtheria — particularly 
so in recent epidemics. The drug is of special value in 
the treatment of pertussis (whooping cough) although 



115 

its value here is probably due more to its hyp- 
notic and antispasmodic properties than to antiseptic 
activity. It has also anesthetic properties somewhat 
similar to those of chloroform. Usual dose 1-5 minims 
in alcoholic liquors or syrup of acacia or paregoric. 

Bromol. — This substance, also called Tri hromo- 
phenol, is prepared by the action of bromin upon an 
aqueous solution of phenol and has the chemical 
formula CgHjErgOH. When pure it occurs as a white, 
crystalline substance with a sweetish yet astringent 
taste and a strong disagreeable odor like that of bromin 
itself. It is insoluble in water but is readily soluble in 
alcohol, ether, chloroform, glycerin and the fatty and 
ethereal oils. Bromol has been employed successfully 
as an intestinal disinfectant in cholera infantum and 
typhus fever and also as a local remedy in diphtheria. 

Bromol is best used, locally, as a solution in glycerin 
of a strength of 1:25, Internally, especially in choleraic 
troubles in children, it may be given in doses of 1-12 
to 1-4 of a grain. 

Bromo Phenol. — This substance, which is Ortho- 
bromo-phenol, is a dull, violet colored liquid with an odor 
like that of carbolic acid (phenol), of which it is a bro- 
min derivative. According to Squibb this substance 
must have the chemical formula CeBrgOH. It is soluble 
in water, alcohol, ether and alkalies. Tchourilow 
reports, from St. Petersburg, excellent results follow- 
ing its use in twenty cases of erysipelas; hie employed it 
in the form of a 1-2% ointment made by incorporation 
with soft paraffin. Good effects followed its use iu 



116 

anthrax and tetanus experimentally produced in 
rabbits. 

Butyric Acid. — This substance is utterly devoid of 
germicidal power. Koch found that an immersion of 
anthrax spores in the acid for five days did not result 
in their destruction. This acid is the fourth member 
of the group of so called "fatty acids" and has the 
chemical formula C3HYCOOH 

Calcic Chlorid. — CaClo. Highly deliquescent and 
freely soluble in water. Koch demonstrated that even 
a saturated aqueous solution of the salt is incapable of 
killing anthrax spores. Miquel has determined that it 
is antiseptic in Ihe proportion 1:25. 

Calcic Hydroxid (Lime Water). — Ca (OHjj. Pfuhl 
found in experimenting upon the effect of "lime water" 
upon typhoid stools that 3% would sterilize them in six 
hours and that 9% would sterilize them in two hours. 
Lime water is produced by the action of water upon 
quick lime; Kitasato found that a solution containing 
.1% of quick-lime (CaO) had the power of killing the 
typhoid bacilli and the cholera spirilla in five hours. 
Jaeger made experiments with a view to determining 
the power of lime-washes; one application destroyed 
several pyogenic and pathogenic species in twenty-four 
hours but had no effect upon the Bacillus tuberculosis^ 
even after three successive applications. 

Calcic Hypochlorite ("Chloride of Lime"). — 
Ca(C10)2. Commonly called "chloride of lime" — it is 
not the chlorid (CaClg) but chiefly the hypochlorite 
(CaCl-iOa), although it does frequently contain portions 



117 

of the chlorid. It is prepared on the large scale by 
the action of chlorin upon calcic hydroxid or else 
quick-lime and is a white powder with a chlorin- 
like odor. When exposed to the air it becomes 
damp by absorption of atmospheric moisture, that 
is, it is hygroscopic; this absorption of moisture 
is accompanied however by a chemical decompo- 
sition with a gradual evolution of free chlorin, 
which is an active disinfectant and bleaching agent. 
Good "chloride of lime" should contain at least 25-30% 
of available chlorin. This substance is one of our best 
domestic germicides and is of great value— not in the 
treatment of wounds but in the disinfection of infected 
articles. In order to be effective against bacilli and 
spores, as found in the fecal discharges, it must be used 
in a 4 per cent solution containing at least 25 per cent 
of available chlorin, although somewhat weaker solu- 
tions will be almost as efficacious. The American Pub- 
lic Health Association maintains that a solution con- 
taining .25 per cent of available chlorin is an efficient 
germicide even when allowed to act for one or two 
minutes. Duggan found that .06 per cent would kill 
the spores of Bacillus a?ithracis and Bacillus sub ti lis \n 
two hours* Nissen in his important experiments upon 
this substance with a view to determining its germicidal 
power demonstrated that a .12 per cent solution was 
able to kill typhoid bacilli and cholera spirilla in five 
minutes; a .1 per cent solution would kill anthrax bacilli 
in one minute; a 5 per cent solution would destroy 
anthrax spores in thirty minutes and a 1 per cent solu- 



118 

tion would produce the same result in seventy minutes. 
He also determined that .5-1 per cent would destroy the 
germs of cholera and typhoid, in feces, in ten minutes. 
Certainly, it seems to be the dmnie(ii2iuij>ar excel/ence 
for sterilization of infectious stools and other dis- 
charges. 

Calcium Salicylate. — CaC7H403 .HgO. This sub- 
stance ocGurrs as a white, tasteless, odorless and cry- 
stalline powder not readily soluble in water. It is said 
to be especially valuable in such intestinal disorders of 
children as diarrhea and gastro-enteritis. It is usually 
administered in doses of 8-24 grains. 

Camphor (Laurinol). — CioHigO, A gummy sub- 
stance obtained from the Laurus camphora which is in- 
digenous to the eastern portion of Asia. It is a vola- 
tile solid which occurs in white, translucent masses of 
a tough consistency and a crystalline structure. It has 
a characteristic penetrating odor and toxic properties. 
It is nearly entirely insoluble in water but is soluble in 
alcohol, ether and chloroform. The experiments of 
Arloing, Thomas, Cornevin, Cadeac and Meunier dem- 
onstrate that camphor has little if any germicidal power. 
It required from eight to ten days to kill the spirilla of 
cholera and the bacilli of typhoid fever, which germs 
are by no means highly resistant. 

Carbolic Acid (Phenol). — Also termed Phenyl al- 
cohol, Phenyl hydroxide Phenyl hydrate^ Hydroxy lb enzene 
CgHsOH. Crude carbolic acid is a reddish-brown 
neutral (not acid) liquid with a strong empyreumatic 
and disagreeable odor. It is obtained by the distilla- 



119 

tion of coal-tar and contains phenol, cresol and other 
substances. The pare acid is obtained by the fractional 
distillation of the crude product and occurs either in the 
form of colorless acicular crystals or else in crystalline 
masses produced by the interlacing of such crystals. It 
IS usually colorless when pure but becomes faintly 
pinkish upon keeping or upon exposure; it has a charac- 
teristic aromatic odor, which in the imperfectly purified 
grades is like that of creosote. Carbolic acid is deli- 
quescent—indeed the very best acid to be obtained in 
the market contains from two to four per cent of water 
and even very good acids may contain more than this. 
Wheu exposed freely it forms an oily liquid, due to 
the absorption of atmospheric moisture. When diluted 
it has a sweetish taste followed by a burning and caus- 
tic sensation. It produces a benumbing effect when 
placed in contact with the living tissues and hence is 
used, either free or combined, for the production of 
local anesthesia. It is also caustic in strong solutions. 
Carbolic acid is freely soluble in alcohol, glycerin, 
benzene, ether, chloroform, carbon di sulphid, the vola- 
tile oils, the fixed oils and aUo to some extent in aque- 
ous solutions of the alkalies. It is generally stated, 
even by many go- called authorities upon the subject, 
that the acid is soluble in twenty parts of water only, 
but this is untrue, for Allen has found it to dissolve in 
10.7 parts by weight of water for one part of absolute 
acid— making its solubility nearly twice as great as that 
ordinarly given. The acid has also the power of dis 
solving about 27% of water, as Allen has also deter 



120 

mined, and not 5% as usually given. With elevation 
of temperature a larger proportion of water can be held 
in solution, becoming turbid upon cooling. When 5% 
of water has been absorbed it becomes permently liquid 
and the acid is usually dispensed in this condition. 

By far the greatest use of carbolic acid, or phenol, 
in medicine is as an antiseptic and germicide. The an- 
tiseptic and disinfectant properties of coal-tar were 
recognized by Chaumette as early as the year 1815. 
These valuable propertise were recognized and their 
existence in coal tar confirmed by G^uibourt fl833), 
Siret (1839), Bayard (1846), Le Boeuf (1850), Calvert 
(1857), Lemaire (1860) and Dumas. Dumas called at- 
tention to the fact that carbolic acid existed in coal-tar 
and to it was probably due its antiseptic virtues. 
Lemaire experimented with coal-tar saponine and also 
carbolic acid — in 1863 appeared his little work "Z>^ 
Vacide pheniqueP which created such wide-spread in- 
terest. Since that time the manufacture of carbolic 
acid became an industry. Lemaire was the first to use 
carbolic acid to any extent and was among those who 
early recognized the truth of the germ theory as applied 
to wounds and wound complications— he was, as some- 
one has said, "an advanced treater of wounds with an- 
tiseptics, nothing more." But really what more could 
one want or demand at this early stage, before the 
birth of systematic antiseptic methods? Carbolic acid 
was also the first antiseptic agent made use of by 
Lister; it is one of the oldest and bent studied of all 
antiseptics-— indeed to this^very drug is due the credit 



121 



ofi opening and founding the new era in surgery. 

Hare ranks carbolic acid next in importance and 
efficiency to mercuric chlorid (corrosive sublimate) 
which he places lirst as an antiseptic and germicide. 
He calls special attention to the fact that it is equally 
valuable in albuminous and non-albuminoua solutions, 
which is not true of mercuric chlorid. Carbolic acid is 
a reliable antiseptic in comparatively weak solutions, 
such as 1:20, and even 1:40 may be depended upon. Its 
complete admixture with all of the secretions allow of 
its complete penetration into all parts of a wound sur- 
face and thereby thorough disinfection is obtained. 
Carbolic acid also possesses the advantage of not being 
neutralized by the substances found in the excreta or 
by the presence of albumin, although it causes coagula- 
tion of the latter. Bolton found that the addition of 10 
per cent of albumin to a bouillon culture did not ma- 
terialiy influence the action of the carbolic acid thereon. 
Even Koch, who advocated corrosive sublimate so 
strongly at one time, says that carbolic acid affords an 
excellent means of destruction for a certain category of 
micro organisms, indeed a very great number. While 
carbolic acid or phenol is of undoubted value as an an- 
tiseptic and germicide yet its compounds, of which 
there are hundreds, are all inferior to carbolic acid it- 
self, according to Koch. 

The antiseptic virtues of the acid have been indubit- 
ably proven by numerous experiments. Cheyne found 
that if milk was poured from one vessel to another 
within the influence of the carbolic spray and then se- 



122 

curely sealed that it would remain unchanged for at 
least two months. Grace Calvert (18Y0) found that 
albumen was preserved by admixture with carbolic acid. 
Dougall found that a solution of the strength of 1:2,500 
was suiEcient to destroy not only spermatozoa but also 
the higher infusoria. Schroeter (1878) found that a 
solution of 1:2,000 was sufficient to preserve flesh four 
weeks and that a strength of .2% (1:500) preserved it 
permanently. Hoppe-Seyler and Baxter determined 
that a 2% solution the acid destroyed the infective 
power of vaccine with certainty; this was also corrobo- 
rated by many others. The germicidal power of the 
drug has been studied by Calvert, Dougall, Schroeter, 
Baxter, Sternberg, Hoppe Seyler, Hugge, Koch, Rosen- 
bach, Davaine, Blythe, Arloing, Cornevin, Thomas and 
others upon almost all known forms of organisms. 
Many of these investigators claim that an aqueous solu- 
tion of 1% is sufficient to destroy the infective power 
of ordinary septic and purulent matters and that 2% 
will destroy the infectious principle of vaccine and 
glanders. Miquel has determined that it is antiseptic 
in the proportion of 1:333 but the experience of Dougall, 
Schroeter and others seem to indicate that this is far 
too low a power to assign to it. 

Koch found that in the absence of spores a 1% solu- 
tion was sufficient to quickly destroy basteria, but that 
anthrax spores require at least 3 per cent in order to ob- 
tain this result and 5 per cent in some cases. The ex- 
periments of La Place however indicate that the addi- 
tion of hydrochloric acid materially increases the germ- 



123 



icidal power for spores. Yersin found that 1 per cent 
would destroy the tubercle bacillus in one minute while 
5 per cent would do this in thirty seconds, Nicati and 
Rietsch determined that .5 percent (1:200) would kill 
cholera spirilla in ten minutes. Schill and Fischer 
found that a 3 per cent solution was sufficient to destroy 
the infectious power of tuberculous sputa, but that a 5 
per cent solution was required to destroy pure cultures. 

Davaine determined that 1 per cent would destroy 
anthrax bacilli in fiesh blood in one hour. Sternberg 
found that 1:125 solutions destroyed pus cocci and 
1:200 solutions destroyed the Micrococcus Pasieuri in 
two hours. It is interesting to note that Koch has prov 
en that solutions in oil or alcohol are much less efficient 
than aqueous solutions. Bolton proved by two hours 
action upon fresh bouillon cultures that a 1 per cent 
solution would destroy the bacilli of typhoid fever, the 
spirilla of cholera, the bacteria of green pus 2Lr\di Staphy 
lococcus pyogenes albus^ aureus and citrus and Streptococcus 
pyogenes (the pus cocci causing putrefaction, the chief 
foes of the surgeon). The experiments of Douglass and 
Baxter led them to the conclusion that aerial disinfec- 
tion by carbolic acid was practically impossible. Stim- 
son corroborated these results as far as the use of the 
spray for this purpose is concerned. 

It is clear then that to be effective as germicides 
solutions must have a strength of at least 1:40. The 
two chief objections which have been raised against the 
use of carbolic acid in wounds are {a) the oozing which 
its use seems to cause, and (^) its caustic or irritating 



124 

properties which are not great. Attempts have been 
made to meet these objections in several ways; the 
methods which seem to give more promise of success 
than all others are those in which the acid is combined 
with something else in the form of a powder which is 
not only absorbent but which also, either by direct 
union with the acid or else by its own peculiar soothing 
and emollient effect, robs the acid of its irritant prop- 
erties, slight as they are. 

At the German Congress of Medicine, held at Wies- 
baden, April 12-15, 1393, Professor von Ziemssen re- 
ported very satisfactory results from the use of injec- 
tions of 1-2 c.c. (about eight minims) of a 2 per cent 
solution of carbolic acid into the substance of the tonsil 
in many cases of catarrhal inflammation of the throat. 
The temperature fell almost immediately, and in every 
case recovery took place rapidly. The same method of 
treatment was also successful, though less constantly, 
in diphtheria, where its effects, however, were less rapid. 
In a case of scarlet fever of a grave character, compli- 
cated with erysipelas, which caused a considerable rise 
of temperature, the desired result was obtained with 
two injections. It a late issue of his "Ephemeris" 
Squibb says: **Carbolic acid still holds prominence 
over its many and increasing rivals. * ^ * During 
the past year a new series of derivatives of this acid 
has been produced from essential oils, and patented in 
Germany, which claim to be odorless, tasteless, neutral 
in reaction and to cause no irritation. These deriva- 
tives when obtainable will have to be closely studied 
therapeutically." 



125 



It is of the very greatest interest in this connection 
to note how history repeats itself; carbolic acid was 
among the first of antiseptic substances introduced into 
common practice. For a period of time recently corro- 
sive sublimate has enjoyed the confidence of practi- 
tioners of antiseptic surgery. Since the time when he 
first announced his principles Sir Joseph Lister has been 
working unceasingly in a search for the ideal and per- 
fect antiseptic; many were devised only to be cast aside. 
Carbolic acid has received renewed prominence over its 
great rival, mercuric chlorid (corrosive sublimate), by 
the renewed allegiance of its original promoter, Lister. 
In his "Address on the Antiseptic Management of 
Wounds," delivered in the London Post Graduate 
Course, at King's College Hospital, on January 18, last 
(Brit. Med, Journ., Vol L, 1893, p, 161), he declared 
his complete and unqualified abandonment of corrosive 
sublimate in favor of his first choice, carbolic acid. The 
strength which he now adopts is 1:20, which he de 
clares to be completely trustworthy for surgical pur- 
poses. Its greater efficiency as a germicide is not 
only established, but he also finds it greatly to be 
preferred in other respects. He furthermore said: 

"Carbolic acid has a powerful affinity for the epider- 
mis, penetrating deeply into its substance; and it min- 
gles with fatty materials in any proportion. Corrosive 
sublimate solution, on the other hand, cannot penetrate 
in the slightest degree into anything greasy and there- 
fore as the skin is greasy, those who use corrosive sub- 
limate require elaborate precautions in the way of 



126 

cleansing the skin— treating it with oil of turpentine or 
ether, not to mention soap or water, lo remove the 
grease which they feel it essential to get rid of for the 
efficient action of the corrosive sublimate. Now all 
this is unnecessary care if you use carbolic lotion. I 
can testify to this from very ample experience. For 
my part I do not even use soap and water. I trust to 
the carbolic acid, which, by its penetrating power and 
great affinity for organic substances, purifies the in- 
tegument in a way that inorganic salts, like corrosive 
sublimate, cannot." This renewed allegiance of Lister's, 
coming as it does at a time when the investigations at 
the Johns Hopkins University and the University of 
Michigan cast considerable doubt upon the existence of 
the high degree of activity which has usually been as- 
cribed to corrosive sublimate, has a peculiarly weighty 
significance. 

Carvacrol.— A substance, said to be a phenol, oc- 
curring in the essential oil of several plants of the 
species Origanum, Its chemical composition is C12H14O. 
It is a thick oily body, its iodid being a yellowish- 
brown powder. The salt is insoluble in water but 
freely soluble in ether, chloroform and olive oil. It 
has been used locally, in the form of powder, ointment 
and as gauze, as an antiseptic in diseases of the skin 
and as a substitute for iodoform in the treatment of 
wounds and ulcerations. 

Crinoline (Quinoline). — C9H7N. A substance ob- 
tained from chinonine or quinine by distillation; it may 
be also synthetically prepared. It is, when pure, a 



127 

colorless liquid with a characteristic, pungent and arom- 
atic odor. It is almost insoluble in cold water but 
freely soluble in alcohol, ether and hot water. It has 
been mainly used as an antiseptic. It is used locally as a 
10% solution in rectified spirit or else peppermint water 
Internally the dose of chinoline itself is 3-10 minims; 
of the tartrate, 5-15 grains. 

Chloral (Tri-chloraldehyd). — Sternberg found 
that a 20% solution required two hours to kill pus 
cocci. Miquel has determined that it is antiseptic in 
the proportion 1:107. Evidently it possesses no great 
germicidal power. Chemical formula, CCigCOH; the 
hydrate, CCI3CH (OH), or better CCI3 COH.H^O. 

The antiseptic properties of chloral were first noticed 
by Hirne and Dujardin Beaumetz in 1872. The subject 
has been also investigated by Keen and Personne. It 
has been shown, as Wood says, that a solution of twenty 
to forty grains to the ounce will preserve animal tissues 
for a great while, probably indefinitely. Even the 
finest microscopical structure appears to remain un- 
injured by this strength. In his first experiences with 
the drug. Dr. Keen hoped that as long as it does not 
affect the color of the tissues it might prove useful in 
the dissecting room; subsequent trials have confirmed 
this. Dr. Keen has also found the drug efficient in 
keeping the urinals of paraplegics and others suffering 
from incontinence of the urine free from the objection- 
able odor. However the drug has no great germicidal 
power. 

Chlorin. — Chemical symbol, CI. Chlorin is a gas. 



128 

officinal in aqueous solution. The value of chlorin and 
its compounds as disinfectants have been known ever 
since their discovery in the latter part of the last 
century (17'74). Indeed all of the haloid elements have 
distinct germicidal properties, Guyton, as early as 
1'795, recommended the use of chlorin by fumigation. 
When brought into contact with organic substances in 
the presence of moisture chlorin unites with the hy- 
drogen of the water thus: 

H20 + Cl2=2HCl + 
and liberates nascent oxygen, which has marked anti- 
septic properties. Hence its action is due not to direct 
action of chlorin itself bat to its strong affinity for hy- 
drogen and the nascent oxygen formed by its union 
with the hydrogen of water. In this same way it has 
the power of deodorizing and destroying sulphuretted 
hydrogen, which is generated by the decomposition of 
albuminous bodies, such as eggs. The germicidal 
power cf chlorin is very great, much more so, in fact 
almost entirely so, in the presence of moisture for the 
reasons above given. In the presence of moisture how- 
ever it bleaches as well as disinfects. Fisher and Pros- 
kauer found that dried anthrax spores exposed for one 
hour to an atmosphere (diy) containing 44.7% of dry 
chlorin gas were not destroyed. In the presence of 
moisture one hour's exposure to an atmosphere con 
taining only 4% of chlorin gas was sufficient to eJffect 
their destruction — indeed even 1 per cent produced this 
result in the presence of moisture if the exposure was 
prolonged to three hours. The experiments of Fisher, 



129 

Proskauer, Kochj Sternberg, De la Croix and others in- 
dicate that the germicidal power of the gas is very 
great in the presence of moisture, otherwise it is almost 
niL Rohe thus sums up our knowledge of chlorin: 

1 Chlorin is an efficient disinfectant when present in 
the proportion of one part in one hundred; provided the 
air and the objects to be disinfected are in a moist 
state and the exposure continues for upwards of an 
hour. 

2. Chlorin, when used in sufficient concentration to 
to act as a trustworthy disinfectant, injures colored 
fabrics and wearing apparel. 

3. The use of chlorin, and in a greater degree of 
bromin, requires considerable experience in manage 
ment; when carelessly handled they may cause incon- 
venient or even dangerous symptoms in persons using 
them; for these reasons they are not suitable as dis- 
infectants for popular use. 

These same remarks also appertain to the other 
members of the halogen group of chemical elements, 
such as iodin and bromin. 

Neither chlorin in substance nor in aqueous solution 
are used to any great extent in internal medication; 
although some experimenters have used it empirically 
as an inhalation in the treatment of certain infectious 
diseases of the pulmonary tract, more especially pul- 
monary tuberculosis. Vaporized iodin has also been 
used in the same manner in the same class of diseases. 
By far the most efficacious disinfectant of all of the 
chlorine compounds in common use is the so called 
^^Chloride of Lime". 



130 

Chloroform (Tri chlor methane).— This substance 
has the chemical formula CHC'3. Its chemical and 
physical properties are too familiar to physicians to 
need further discussion or description. 

Kirchner found that 1 per cent killed cholera spirilla 
in less than one minute while typhoid bacilli required 
exposure for at least an hour to the influence of 1-2 per 
cent ( 5 per cent) to effect the same result. In the ex- 
periments of Salkowski it was determined that, in the 
absence of spores, anthrax bacilli and cholera spirilla 
were killed in half an hour by exposure to the drug. 
Koch found that anthrax spores, however, did not have 
their vitality destroyed even by one hundred days' im- 
mersion in chloroform. Evidently then the action of 
the drug, as a germicide, is directed to the parent cells 
and seems to have little or no effect upon spores— at 
least those of the more resistant germs. 

Chloro-phenol (Tri chlor -phenol). — This sub- 
stance is a derivative of phenol (carbolic acid) in which 
three atoms of hydrogen are replaced by three atoms of 
chlorin and hence it has the chemical formula CgHgCIs. 
OH. It occurs in the form of colorless, needle-like 
crystals with an odor of phenol, which is more strongly 
marked than in its allied substitution product called 
Bromo pheiiol and which it remarkably resembles in solu- 
bility as well as properties. 

Chlorphbnol (Mono chlor phenol). — This sub- 
stance is phenol in which one of the hydrogen atoms 
of the phenyl (CeHs) is replaced by one atom of 
chlorin, thus CgH^CLOH. It occurs as a volatile 



131 

liquid heavier than water and possesses antiseptic prop- 
erties. It is said to have been employed with good re- 
sults in tuberculous diseases, bronchitis, laryngitis, 
ozena, discharging glands, ulcers and wounds. It is 
usually administered by inhalation but is also employed 
as a local application. 

Chromic Acid. — This substance has the chemical 
formula H2Cr04. It is obtained by the treatment of 
potassic dichromate with sulphuric acid and by dis- 
solving the resulting long, red, hygroscopic, rhombic 
prisms of needles of chromic anhydrid (CrOo) in water. 
It mixes with water in almost all proportions. The 
substance is employed in concentrated solutions as a 
powerful caustic in the treatment of tumors, excrescen- 
ces, syphilitic tumors or ulcers, etc. It can be used in 
various strengths, such as 1-5 per cent. It is often used 
for sterilizing and hardening various surgical prepara- 
tions. In ozena and-gODorrhea, aqueous solutions of the 
drug in the streiigth 1:1000 have been used. As anti- 
septics chromic and osmic acids are of about equal 
values. Koch's experiments indicate that it is markedly 
germicidal, a 1 per cent solution destroying anthrax 
spores in one to two days. Miquel has determined that 
it is antiseptic in the proportion 1:5000. Its chief ob- 
jection is the fact that it is exceedingly irritating and 
caustic, indeed cases are reported in which death has 
been ascribed to its free use. 

Chrysarobin. — C30H26O7. Obtained from the wood 
of the tree, Aftdira araroba. The drug occurs in orange- 
yellow or golden, shining, tasteless needles which are 



132 

soluble in alcoholj ether, chloroform, benzene, alkaline 
and acid solutions and slightly so in water. It is chief- 
ly used as anti-parasitic in the treatment of various 
affections of the skin and is said to have given especial- 
ly good results in psoriasis. Externally it is applied 
usually in the form of an' ointment of 10 per cent 
strength. Internally the dose is from 1-8 to 1-4 of a 
grain. Its internal use is however comparatively re- 
stricted and seldom resorted to. 

Citric Acid.— HgCgHgOt.HaO. Citric acid is a tri- 
basic organic acid found in the juices of many fruits 
such as the strawberry, raspberry, currant, cherry, etc., 
but especially in the lemon, from which fact it receives 
its name. It occurs in the form of colorless crystals 
which are readily soluble in water. Van Ermengem 
determined experimenta,lly that .5 per cent (1:200) was 
sufficient to kill cholera spirilla in half an hour. Kita- 
sato found that .43 per cent killed typhoid bacild in 
five hours and .3 per cent would kill the cholera germ 
in the same time. Clearly then the substance possesses 
germicidal powers which are very manifest in the case 
of the less resistant germs at least. 

Coffee Infusion.— The experiments of Heim and 
Luederitz indicate that this substance possesses antisep- 
tic and feeble germicidal power. To what ingredient 
this was due they did not determine but agreed that it 
was not dependent upon the caffein. 

Corrosive Sublimate (Bi-Chloride of Mercury, 
Mercuric Chlorid), — HgClj. This substance occurs 
as a heavy white powder or in colorless, rhombic crys- 



133 



tals or else in crystalline masses; it crystallizes from 
concentrated solutions in hot water in the form of 
acicular or needle-like crystals. When heated it fuses. 
It has an acrid, metallic taste and an acid reaction and 
is strongly poisonous and antiseptic. Is used chiefly in 
medicine as an antiseptic or else in the internal treat- 
ment of syphilis. It is soluble in cold water and gly- 
cerin but much more so in hot water, alcohol and ether. 
Up till the year 1881 the favorite and indeed almost 
universal antiseptic was carbolic acid; but in that year 
Koch announced his belief in the superior efficacy of 
mercuric chlorid and the tide of popular favor surged 
largely in the direction of the latter drug. This action 
was based upon experimental evidence which seemed to 
indubitably demonstrate the superior germicidal power 
of the mercurial salt. For instance it was stated that a 
l:300j000 solution would restrain the growth of anthrax 
spores while a 1:1,000 solution would destroy them. In- 
deed most of the authorities of the surgical world . 
seemed convinced by the evidence brought to bear in 
favor of mercuric chlorid. Sternberg said that the ex- 
perimental data indicated that its use for disinfection 
in strengths of 1:500-1:1,000 was reliable for material 
containing spores and in the strength of 1:2,000-1:5,000 
for pathogenic bacteria in the absence of spores, but 
that due regard must be had for the fact that the pres- 
ence of albumin very materially reduces its germicidal 
potency. We now know, however, that even the very 
strongest solution (1:500) which he gave is not able to 
destroy pus cocci and other micro-organisms, even in the 



134 



absence of spores. We know now that its action is that 
of inhibition and not destruction. In the year 1883 
Sternberg gave the following table of the relative values 
of various germicidal, or supposed germicidal, agents: 

Efficient. 



Mercuric chlorid . . 
Potassic permanganate 
lodin . . . . . 
Creosote . . . , 
Sulphuric acid . . 
Carbolic acid , . 
Hydrochloric acid 
Zinc chlorid , . . 
Tr. of Ferric chlorid 

Salicylic acid . . 

(Dissolved with b 
Potassic^hydroxid 
Citric acid . . 
Chloral hydrate 

Failed. 



orax) 



1:20,000. 
1:833. 
1:500. 
1:200. 
1:200. 
1:100. 
1:100. 

1:50. 

1:25. 

1:25. 

1:10. 
1:8. 
1:5. 



PER CENT. 

. 40. 



Fowler's solution 

Sodic "hyposulphite" ..... 32. 
Sodic sulphite (exsic.) ..... 10. 

Ferric (?) sulphate 16. 

{Ferrous is probably rBeant). 



135 



Potassic iodid 8. 

Zinc chlorid (liquid) 8. 

Zmc sulphate 20. 

Boracic acid (sat. soL) ..... 4. 

Sodic borate (sat. sol.) , ... . 4. 

Sodic salicylate 4. 

In these experiments of Sternberg the micrococci of 
pus were used and further experimentation conducted 
with the micrococci of septicemia, the Bacterium termo 
and the bacteria of *'brokendown beef tea" indicated 
that their relative values as germicides remained prac- 
tically the same. 

For a long time it (mercuric chlorid) was considered 
one of the very best of all germicides. 

Even Koch in his advocacy of corrosive sublimate 
said that while solutions of 1:10,000, 1:20,000 or even 
1:30,000 exert an inhibitory and sometimes toxic action 
upon germs and spores when brought into direct con- 
tact with them, a much stronger solution is required for 
prompt destruction. In some cases the results obtained 
where wholly negative; thus, fresh tubercular sputum 
remained infectious even after an exposure for twenty' 
four hours to a solution of a strength of 1:2,000. More- 
over the substance is exceedingly prone to decompose 
in the presence of albumin, chemically combining with 
it and thereby losing much of its antiseptic activity and 
also rendering it difficult to forecast the certainty and 
extent of its action when such conditions obtain. 

Recent investigations conducted at the Johns Hop- 



186 

kins University and at the University of Michigan hav6 
shown that solutions of mercuric chlorid, when used as 
germicides, are often inert and still oftener actually in- 
jurious to the tissues when applied in surgical opera- 
tions. A long series of experiments at the Johns Hop- 
kins Hospital resulted in defining the limitations of the 
drug as follows: 

1. Under the most favorable conditions, a given 
amount of sublimate has the power of rendering inert 
only a limited number of individual organisms. (It 
does not destroy them). 

2. The disinfecting activity of the sublimate against 
organisms is profoundly influenced by the proportion of 
albuminous material contained in the medium in which 
the bacteria are present. 

Kelly, Robb and Ghriskey, as well as others, have 
proven that even strong solutions (such as 1:500) while 
antiseptic and inhibitory are devoid of any germicidal 
power. Kelly says: "Corrosive sublimate solutions as 
strong as 1:500 are 7tot germicidal after immersion of 
the hands from two to five minutes. The mercury salt 
acts either by mechanically coating or chemically com- 
bining with some portion of the coccus, thus only in- 
hibiting further growth until the salt is precipitated or 
removed. This I have repeatedly shown to be true fol- 
lowing both the ordinary practice of immersion of the 
hands from two to five minutes in 1:500 and 1:1,000 
solutions after a preliminary washing for ten minutes 
with soap and water, and again after carefully follow- 
ing out Fuerbringer's method, now so generally adopted. 



137 

The latter method was distinctly shown to be inefficient 
in almost every instance." After considerable research 
upon the subject he furthermore decides that corrosive 
sublimate, although dangerous on wounds on account 
of the property of coagulating and causing necrosis of 
the albuminous tissues, yet has the valuable pToperty 
of inhibiting, not destroying, the action of those germs 
with which it comes in contact. Indeed Halsted has 
shown that the irrigation of fresh wounds by a solution 
of corrosive sublimate as weak as lo^ooo is followed by 
a distinct line of superficial necrosis which is clearly 
demonstrable under the microscope. Then also, its dis- 
tinct toxic properties must not be forgotten for an in- 
stant; especially is this the case when the substance is 
to be used in intrauterine or vaginal injection, or in 
the serous cavities, or in irrigation in surgical opera^ 
tions. 

The quondam virtues of corrosive sublimate were 
founded primarily upon the dicta of Koch and other ex- 
perimenters. It remained for the present decade to 
demonstrate the faulty conditions underlying these pri- 
mary experiments upon which the reputation of the 
drug was founded and to show that the extravagantly 
high value placed upon the substance, as a direct result 
of such experimentation, was also faulty, not to say 
false. Clinical experience has demonstratad that cor- 
rosive sublimate does possess inhibitory power in a high 
degree, but modern bacteriological research has just as 
clearly demonstrated that such power is purely inhibi- 
tpry and not at all germicidal in nature. Not only is 



138 

its action purely inhibitory but even this action is in- 
fluenced to a great degree by the conditions surround- 
ing the application. Indeed the differences in power 
of corrosive sublimate under different conditions are 
very much greater than those of carbolic acid, — or most 
of the other germicides in fact. Aside from the pres- 
ence of oily materials, which are distinct checks to the 
efficiency of corrosive sublimate, the greatest obstacle 
against its use in the animal tissues and fluids is the 
fact of its precipitation by and with albuminous sub- 
stances. So great are the dimensions of these obstacles 
that many claim that it may be seriously doubted 
whether it is possible to thoroughly disinfect, with cor- 
rosive sublimate, wounds infected with bacteria. It is 
also doubted whether irrigation with solutions of cor- 
rosive sublimate is able to accomplish much more in the 
way of disinfection than is obtained by the use of sterile 
solutions of common salt. 

It is chiefly and especially to Geppert that we owe the 
demonstration that the former methods of testing and 
ascertaining the germicidal power of mercuric chlorid 
were subject to such very grave errors that the results 
obtained therefrom were entirely untrustworthy and far 
from reliable. It was formerly claimed that mercuric 
chlorid had the power of absolutely destroying bacteria. 
Geppert has shown that in order to prove this not only 
must the germ be subjected to the action of the sub- 
stance but at the termination of the exposure the anti- 
septic must be thoroughly removed from the germ; if 
such removal is not thorough even a slight remaining 



133 

amount of the autiseptic may be sufficient to inhibit fu- 
ture development and the erroneous conclusion 
reached that the germ is dead because it does not de- 
velop. Geppert has also shown that the best means of 
ridding the germ of the sublimate is the precipitation 
of the mercurial salt by means of ammonic sulphid, or 
any other alkaline sulphid, in order to determine whether 
bacteria which have been originally subjected to the 
action of the sublimate have been destroyed or not. 
When this precaution of precipitation is taken it is 
found that corrosive sublimate (mercuric chlorid) is far 
less energetic than has been generally supposed. Thus 
Koch believed that from his experiments he had demon- 
strated that corrosive sublimate in the strength ItljOOO 
destroyed anthrax spores in one minute. Geppert has 
shown, however, that the same strength may not have 
killed all of the spores in watery suspension, even at the 
end of three day si Indeed in a recent article he 
has even shown that it is exceedingly difficult to deter- 
mine with any degree of accuracy whether all of the 
spores are destroyed by the sublimate or not; for a 
definite concentration of the reagent (the sulphid) used 
for such precipitation is required in order to effect a 
complete separation of the sublimate from the germ. 
Hence neither failure to obtain cultures after such precip- 
itation, T7or failure of cultures, so treated, to infect an ani- 
mal are proof that the germs or spores have been killed 
by sublimate; for a different concentration or strength of 
the substance used to precipitate the sublimate, or else 
the use of some reagent less injurious, per se^ to the 



140 

spores or germs might show that they possessed still 
greater resistance to the action of the sublimate, as 
Welch has also stated. This is exceedingly plausible 
when we remember that definite concentrations of the 
alkaline sulphids must possess some antiseptic virtues 
and these but reinforce the action of the sublimate, as 
far as the action upon the germ is concerned, although 
resulting in the ultimate precipitation of that compound. 

Abbott has also confirmed several of these results. 
His recent experiences (189J) show that 1:1,000 does 
not always destroy Staphylococcus pyogenes aureus^ even 
after five minutes exposure— in some cases requiring 
as much as ten, twenty or even thirty minutes to in 
hibit their action. In his experience the cyanid and 
iodid are both of higher inhibitory power — although 
the first is exceedingly poisonous. 

In 1884 Professor Klein made the curious statement 
that corrosive sublimate has no more germicidal power 
than vinegar— such vinegar, containing from 6 3 to '7.0 
per cent of acetic acid, prevented the growth and devel 
opment of micro organisms just as effectually as a 
1:1,000 solution of the sublimate. McClintock, of the 
University of Michigan made elaborate experiments 
with a view to testing such statements of Klein. His 
results strongly corroborated those obtained by Klein, 
Geppert, Welch, Kelly, Robb, Ghriskey and others, 
confirming the statement that the actual germicide 
value of corrosive sublimate is very low. Lister 
distinctly states that it is, as a germicide, far inferior 
to carbolic acid, McClintock made exhaustive experi* 



141 

ments with various germs, using solutions of corrosive 
sublimate as the inhibitory agent. His results show 
that it is possible for germs to withstand the action of 
that drug as follows: 

Staphylococcus pyogenes aureus: 

1:1000—23 hours. 1:100—11 hours. 

Saturated solution for one hour! 
Bacillus subtilis: 

1:1000—41 hours. 

Saturated solution for eighty-five mi7iutesl 
The' germ of Swine Plague: 

1:200—1 hour. 
Typhoid bacillus: 

1:1000— 1 hour. 
Germs in Feces: 

1:1000—24 hours. 

Saturated solution for twenty four hours! 
These results fall with astounding effect upon him 
who sees naught save perfection in corrosive sublimate; 
they come home with telling force to Ephraim "who 
is wedded to his idols." 

We may consider it conclusively proven that cor- 
rosive sublimate has comparatively low germicidal pow- 
er although high in inhibitory activity. In using it we 
must be mindful of the following facts: 

1. It is exceedingly poisonous, even in small quanti- 
ties. 

2. It corrodes all of the common metals, depositing 
upon them a thin film of metallic mercury. 

3. It causes superficial necrosis when brought into 



142 

contact with living tissue, even in solutions as weak as 
1:10,000. 

4. It unites with albuminous substances with great 
facility, forming an isoluble and inert (while insoluble) 
compound. Lister has suggested that the albuminate 
of mercury thus formed has antiseptic properties if ren- 
dered soluble. Laplace recommends the combination 
of tartaric acid with the sublimate to overcome this 
tendency to decompose or to combine with albumin. 
Others have recommended the combination of common 
salt or of ammonic chlorid for this same purpose. 

5. It does not owe its virtue to the fact that the germ 
is destroyed, as is commonly believed, but simply to the 
fact that it prevents development of the germ while it 
is present, 

6* The substance when left in contact with organic 
matter, such as sponges or dressings, especially in the 
presence of light or heat, is prone to decompose— be - 
coming thus inert. 

Creolin (Liquor Antisepticus).— This substance is 
a form of Cresol obtained by the dry distillation of Eng 
lish coal. It is said to be a coal-tar product resembliug 
carbolic acid in appearance but with an odor of tar. It 
appears as a black alkaline fluid of the consistency of 
syrup and a specific gravity slightly higher than that of 
water. Its odor is characteristic. It is soluble in alco 
hoi, ether and chloroform and insoluble in methyl alco- 
hol and water — with the latter it forms an opaque emul- 
sion, on this account it can never supersede carbolic 
acid for the sterilization of instruments and the main 



143 

tenance of an aseptic condition of such instruments dur- 
ing a surgical operation. It undoubtedly possesses de- 
cided germicidal power but is inferior in its action upon 
pathogenic organisms to carbolic acid— except in the 
ca«e of the spirilla of cholera. It has by no means de- 
veloped the high germicidal power at first claimed for 
it. It is a cheap and efficient germicide but is decidedly 
inferior to carbolic acid— especially in the presence of 
albumicj its efficiency being almost neutralized by the 
occurrence of as small a proportion of albumin as one 
part in one hundred. It is highly extrolled by Neu- 
doerfer who says that it is "absolutely non-toxic to man; 
is ten times more germicidal than carbolic acid; is sohu 
ble in water^ alcohol and glycerin; it controls hemorrhage 
and pain; it limits suppuration; it injures neither met- 
al nor hands; it is very cheap." He not only enlarges 
upon its advantages, giving the substance properties 
which it never possessed, but he neglects to give its dis- 
advantages. In the first place, it is not '^absolutely 
non-toxic," this has been disproven by experience- 
Martin distinctly says that it is not only toxic but that 
it causes nausea, vomiting and albuminuria. In the 
second place, it is not as efficient, all in all, as carbolic 
acid. In the third place, it is not only insoluble in 
water but forms a non-transparent emulsion with that 
substance. Moreover its odor is decidedly unpleasant 
and the compound itself is unstable. 

It has been previously stated to be a coal-tar product 
but is reported by Dr. F. Raschig to be nothing more 
nor less than a mixture containing about one part of 



144 

resin soap with two parts of crude carbolic acid of about 
twenty per cent strength, although its manufacturers 
claim that it is entirely free from carbolic acid. Squibb 
says that its action as a disinfectant reminds one strong- 
ly of carbolic acid. He also says that unfavorable re- 
sults have also been presented in regard to its use, 

Creosotal. — -A short name recently adopted for the 
so-called carbonate of creosote, which is supposed to 
result from the union of creosote and cardon di oxid. 
At ordinary temperatures it is an oily, amber-colored 
liquid, becoming more fluid upon warming it. It is 
neutral to litmus, odorless and with a faint sweetish 
taste of creosote. It is insoluble in water, dilute alco- 
hol and glycerin, but readily soluble in alcohol, ether, 
chloroform and benzine. It is claimed that the sub- 
stance contains ninety per cent of creosote and is yet 
free from all of the disagreeable properties of the latter 
drug. It is recommended in doses of ^ to 1 drachm daily, 
increasing to one and a half drachms or even as high as 
half an ouoce. It isrecommended'especially of in tuber- 
culous affections of the lungs, or indeed in any condi- 
tion where creosote itself is applicable. 

Creosote.— This substance is a product of the dis- 
tillation of wood tar and resembles carbolic acid in 
many of its properties, more especially those of an an- 
tiseptic nature. It consists chiefly of a mixture of sub- 
stances, such as creosol (CgHioOj) and cresol (C7HgO) 
which are members of the phenol series. The creosote 
prepared from beech wood is chiefly recommended for 
internal administration wher^ so used. Fully ninety 



145 

per cent of the substance dispensed as "pure beechwood 
creosote" in drug stores is naught else than carbolic 
acid. The latter is eliminated chiefly by the kidneys, 
giving the characteristic color to urine, while creosote 
is supposed to be eliminatedj in part at least, by the 
lungs. 

Sternberg in his experiments upon the substance in 
order to determine its germicidal activity found that 
1:200 was fatal to micrococci. Guttman found that it 
was antiseptic in its action upon pathogenic organisms 
in solutions as weak as 1:3000 or 1:4000^ but that in 
such proportions it did not necessarily kill the organism. 
Schill and Fisher demonstrated that 1 per cent failed, 
even after twenty hours exposure, to destroy the Bacil- 
lus tuberculosis in tuberculous sputa. Yersin's experi- 
ments were somewhat confirmatory, he found that a 
saturated aqueous solution did not destroy the tubercle 
bacillus in twelve hours. 

Cresin: — Sometimes also spelled Kresin, Crude 
carbolic acid consists of a mixture of cresols or phenols 
and would be of great antiseptic value but they are al- 
most insoluble in water and according to Laplace are 
almost worthless as disinfectants on that account. In 
order to meet this objection Cresin, which is a solution 
of cresol (25%) in an equal amount of Sodic Cres-oxyl- 
acetate, was prepared. It is a brown liquid, said to be 
entirely free from carbolic acid and with an odor of 
Cresol and forming a clear neutral solution when mixed 
with water. It is said to possess antiseptic properties. 
It is recommended for local use in solutions of strengths 



146 

of from I to 1 per cent. It has not as yet been recom- 
mended for internal use. Its chemical formula is CgH^. 
CH3. OCH3. COOH. 

Cresol,-— The cresols, as Squibb says, are still used 
as disinfectants, but their disadvantages are of su<}h a 
nature that they continue to retard their utility. The 
so-called "Cresolsaponate" is now recommended by 
German practitioners. It is prepared by mixing crude 
carbolic acid with melted soft soap in equal proportions 
to form finally a homogeneous mass which is soluble in 
water. This however but increases the objectionable 
quality inherent in all of the compounds of cresol, name- 
ly that of rendering the surgeon's hands and instru- 
ments disagreeably and dangerously slippery. 

As ordinarily found cresol is a dark reddish-brown 
liquid which is transparent and rather thinner than 
creolin. It has the characteristic odor of tar and forms, 
like creolin, an objectionable and opaque emulsion with 
water. Behring, after a very elaborate series of experi- 
ments with the substance, concludes that it certainly 
has no advantage over carbolic acid. 

Cresol loDiD.—This substance, also called Ortho^ 
cresol iodid^ is another of the innumerable proposed sub- 
stitutes for iodoform. It is a fine pale-yellow powder 
with a pronounced odor, which is agreeable in compari- 
son with that of iodoform however; the drug is insolu- 
ble in water. The compound has not been in use long 
enough to give it any positive status. As Squibb says> 
though the compounds of cresol possess antiseptic power 
they all have the disadvantage of adhering to and ren- 



147 

dering the hands and instruments extremely slippery; 
they also readily oxidize in the atmosphere. These dis- 
advantages apply to all of the various compounds of 
cresol thus far knov/n, such as lysoL saprol, solutol, 
solveol, and others. 

Cresylic Acid. — The article usually sold as cresylic 
acid is commonly a substance of variable composition 
containing various cresols and also sometimes xylenols. 
Whatever antiseptic power it may possess is due en- 
tirely to these substances which it contains. 

CuPKic Chlorid. — CuClg. This substance is not in 
general use as an antiseptic but Miquel has determined 
that it is antiseptic in the proportion 1:1,428. This 
gives it higher power than the sulphate, which is better 
known. 

CuPRic Sulphate.— CuSOi- The sulphate of copper 
is better known than the chlorid although its antiseptic 
properties are not as high as those of the latter com- 
pound. Miquel has determined that the sulphate is 
antiseptic in the proportion 1:11. Its action is decidedly 
inhibited by the presence of albumin. 

Dermatol. — This term is applied to the Sub gal late of 
bismuth; it contains about 55 per cent of the oxid of 
bismuth. It is usually represented by the chemical 
formula,— BiC^H^O^. It is an odorless, yellow, saiSfron- 
like and non-hygroscopic powder insoluble in the ordi- 
nary solvents. Colasanti has made comparative bac- 
teriological experiments with aristol, iodoform and 
dermatol in order to determine their relative germicidal 
potency. None of these agents seemed to affect dried 



148 

cultures even after three days contact; but when moisture 
was present dermatol was effective in little more than 
half the time required by the other two. It also pos- 
sesses remarkable dessicating powers although its anti- 
septic powers are in dispute in many quarters. It is 
chiefly used as a substitute for iodoform. It may be ap- 
plied locally as a dusting powder, on gauze, in glycerin, 
collodion emulsion or in ointment in the strength of 
10-20 per cent. It has been used internally with good 
results in disorders of the gastro-intestinal tract, as a 
substitute for the sub-nitrate of bismuth. Flint reports 
good results from such uses. 

DiAPTHERiN.— (OH.CgHeNs) (OH) (SO3H) CgH,, Al. 
so called Oxy chin aseptoL It occurs as a whitish or 
yellowish powder with an odor somewhat like that of car- 
bolic acid and a ready solubility in Avater and the ordi- 
nary solvents. It is said to be an excellent antiseptic. 
Kronachm*, Emmerich and others claim great virtue for 
it. Its odor is slight and it is said to be entirely free 
from irritating properties. It has been tried with ap- 
parent success in the treatment of wounds, sores and 
putrefactive disorders and many excellent reports of its 
virtues have been made. Unfortunately, however, it 
cannot be used for the disinfection of instruments for it 
attacks even silver and nickel plating; it also stains the 
hands and nails a light yellowe 

Kronacher says that a one per cent solution is fully 
strong enough for surgical dressings, — indeed he has 
even used it in solutions as strong as 50 per cent. 

DisiNFECTOL — This substance is usually termed a 



l49 

coal tar product similar to creolin and largely used io 
Germany. The statement has also been made that it is 
a mixture of hydrocarbons, soaps, carbolic acid and soda. 
It occurs as an oily, dark-brown fluid, analogous to 
lysol and creolin, and slightly heavier than water. It 
is claimed that it possesses energetic disinfectant pro 
perties but if so this has not resulted in its general use. 
It has been employed locally in the form of an emulsion 
of a strength of two to five per cent. 

Beselin concludes, after having made numerous ex- 
periments with it upon typhoid stools, that while superi- 
or to creolin in this respect, it has no advantage over 
carbolic acid. 

Essential Oils. — These have been found to possess 
varying values. Riedlin reports that the oils of laven- 
der, eucalyptus, rosemary and cloves have the greatest 
antiseptic values of any of the essential oi^s. Cadeac 
and Meunier demonstrated that the typhoid bacilli were 
killed by oil of cloves in twenty-five minutes, by oil of 
Ceylon cinnamon in twelve minutes while oil of sandal- 
wood required twelve hours. 

Ether. — (C2H5)20, or C2H5OC2H5. This substance is 
too familiar to need description. Yersin found that ten 
minute's exposure was sufficient to kill the tubercle ba« 
cilli but Koch found that anthrax spores would germi- 
nate even after eight day's exposure to the action of the 
same. 

EucALYPTOL — CioHigO. The essential oil obtained 
by distillation from the eucalyptus. When pure it oc- 
curs as a colorless liquid with an odor somewhat similar 



150 

to that of camphor. It is insoluble in water but soluble 
in the fatty oils, in alcohol, ether and chloroform. It 
is said to possess marked therapeutic properties but its 
chief use is as a local antiseptic in ulcers. 

Behring has determined that it is four times less act- 
ive than carbolic acid. Perret found that a five per 
cent solution had no effect upon tuberculous sputa. 

Recently M. Anthoine has produced a new antiseptic, 
which he calls Eucalypteol, by the acticm of hydrochlo- 
ric acid upon eucalyptus oil. This substance chemically 
is eucalyptene di-chlorid; it occurs in colorless, scaly 
crystals with an odor resembling camphor. It is almost 
tasteless. Lafage claims that it is far superior to euca- 
lyptus oil as an antiseptic. It is practically insoluble in 
water and glycerin and readily soluble in ether, chloro- 
form and alcohol, though decomposed by the latter. 

EuGENOL.—Also termed Eugenic acid, with a chemi- 
cal formula CgHs C3H5.OII.OCH5. This substance is a 
phenol derived from oil of cloves by oxidation; it may 
also be obtained from other various essential oils, such 
as those of sassafras, bay, pimento and cinnamon. It 
usually occurs as an aromatic liquid freely soluble in 
alcohol but only slightly so in water. The substance 
has been used internally as an antiseptic in doses of 45 
minims /^r diem, in alcoholic solution. There is also a 
derivative, Cinnamyl eugenol, which occurs in colorless, 
odorless, tasteless crystals which are soluble in hot al- 
cohol, ether, chloroform and acetone; it has been used 
in the treatment of tubercular diseases. 

EuPHORiN.— This substance is also termed Carbonate 



151 

of ethyl and phenyl. Phcnyl-ethylic ur ethane and Phenyl 
urethane. It is represented by the chemical formula 
CeHsNHCOOCgHs. Euphorin must not be confounded 
with Europhen, which is an altogether different sub 
stance. Euphorin occurs in the form of a white pow- 
der with a slight aromatic odor and a taste like that of 
cloves. It is slightly soluble in water but freely so in 
alcohol. It is employed locally as a dusting powder; 
internally it is given in doses of 7-15 grains from two 
to three times a day. As a local application it is said 
to be more powerfully antiseptic but less dessicating 
than dermatol. 

Europhen, — lodo-di-iso-butyl-ortho-cresol or Di-iso- 
butyl-ortho-cresol-iodid and is represented by the chemi- 
cal formula (C4H9tCH3.C6H30)2HI. It occurs as an 
amorphous powder, with a yellow color and an odor of 
saffron; it is soluble in alcohol, ether, chloroform and 
oils but insoluble in water. It is used chiefly locally as 
a dusting powder as a substitute for iodoform. It is 
also used hypodermically in the treatment of syphilitic 
disorders. Its best effects are obtained by a local use, 
and even then only by its application to secreting or 
otherwise moist surfaces. Kopp reports excellent re- 
sults from a mixture of europhen and boracic acid. 
Christmann concludes from his experiments that the 
evolution of iodin is necessary before an exhibition 
of germicidal power— this is dependent upon the de- 
composition of the drug, as in the case of iodoform. 

Exa^lgine.— A substance, also termed Methyl-acetani- 
lid, obtained by the action of acetyl chlorid upon mono- 



152 



methyl-anilid and possessing the chemical formula 
C6H5N(CH3)CH3CO. It occurs as a tasteless powder 
made up of crystalline, needle-like particles which are 
readily soluble in alcohol and sparingly soluble in water. 
It is said to possess antiseptic properties but these are 
not marked, at least not sufficiently marked to make the 
substance of any great value in this connection. 

Ferric Chlorid.— FeCL, frequently given as FeoClg. 
A 5 per cent solution of the substance required five 
days to destroy anthrax spores, failing to do so in two 
days. Ko marked germicidal power. 

Ferrous Sulphate. — FeSO^. Sternberg found that 
a 20 per cent solution failed to kill putrefactive organ- 
isms — that it was antiseptic, not germicidal. 

Formalin. — H.COH. This substance is nothing 
more nor less than an aqueous solution of formic alde- 
hyde of the strength of 40 per cent. It has its laurels 
yet to earn. 

Formic Acid.— H.COOH, This irritating substance 
is formed either by the distillation of the bodies of ants, 
as was formerly done, or else by the oxidation of formic 
aldehyde, which is in turn produced by the oxidation of 
methyl alcohol, Kilasato determined experimentally 
that .35 per cent would destroy typhoid bacilli in five 
hours and that .22 per cent would produce a like result 
in the same time upon the spirilla of cholera. 

Gallic Acid.-— Abbot determined that a 2. 37% solu- 
tion destroyed the bacteria of broken-down beef tea but 
failed to kill anthrax spores in two hours. A solution 
of 1;142 killed various micrococci in two hours. 



153 

Glycerin. — C3H5 (OHjg. Glycerin was used as an 
antiseptic by Demarquay as early as 1855; he thought 
it the very best antiseptic substance, in fact almost a 
panacea; but it has been tried and found wanting. 
Koux and others have shown that the addition of five 
per cent of glycerin to culture media w^^ favorable to 
their subsequent growth. Koch found that it had no 
effect upon the spores of either symptomatic anthrax 
nor indeed upon those of anthrax itself. Miquel has 
determined that its presence in the proportion of 1 :4 
will prevent putrefactive decomposition in bouillon. 

Gold Chloeid.— AuClg, Also termed the tri chlorid, 
or Auric Chlorid, Miquel has determined that this 
substance is antiseptic in the proportion of 1:4000, A 
solution of 1:1000 will destroy the germs of cholera, 
anthrax or diphtheria. 

GuAiACOL.— This substance, also called Methyl pyro 
catechin, is obtained from beech wood tar. Its formula 
is said to be Cell^OHOCHg and it is claimed to contain 
60-90% of creosote. It occurs as a liquid having a 
pleasant odor and a specific gravity only slightly greater 
than that of water. It has also been produced synthe- 
tically as a solid product which is colorless and crystal- 
lizes readily in prismatic form; it has a sweetish and 
marked astringent taste and is said not to attack 
mucous membranes. 

Guaiacol is soluble in water in the proportion 1:85 
and in petroleum benzin in that of 1:8. It seems to 
have antipyretic, as well as antiseptic, properties— even 
when applied locally. Its chief use has been in tuber* 



154 

culous affections, and indeed wherever creosote may be 
exhibited with profit. It is said to prove an advan- 
tageous substitute for creosote in the early stages of 
tuberculosis. It is best administered after meals either 
in alcoholic solution, or mixed with cod-liver oil or else 
in capsules. The usual dose is from five to ten minims; 
continued use establishes a tolerance, as in the case of 
creosote, and the dose may be gradually increased if 
its full effect is to be exercised. 

Various salts of the substance, such as the iodid, car- 
bonate, salicylate and others, have been prepared and 
put upon the market as succedariea for guaiacol itself; 
the indications for their use are the same as those for 
guaiacol, the only virtue claimed for any of them over 
guaiacol is that they are supposed to possess the dis- 
advantages, such as irritation, etc., in a more modified 
degree than the substance itself. 

Helenin.— This substance is derived from elecam- 
pane root. It exists in the form of white acicular 
crystals with the chemical formula CgHgO These crys- 
tals are only slightly soluble in water but are readily so 
in hot alcohol, ether and the oils. It is claimed to be 
an effective antiseptic where it has been used in Europe. 
In Spain it is highly favored as a surgical dressing; 
indeed Ferran claims active germicidal properties for it, 
claiming that it is more destructive in its action upon 
the cholera bacillus than any other agent. It has been 
used with favorable results in pertussis, ozaena, diar- 
rhea, leucorrhea and other disorders; but its excessive 
cost is an effective barrier to its general use. It has 



155 

been administered in doses of 1-6 to 1-3 of a grain in 
the course of twenty-four hours. 

Hydrochinone.— Also termed Hydro qiiinone^ Para 
di oxy benzene ^^niQuinol, is obtained from Arbutin 

(which see) by the action of sulphuric acid, or else by 
the oxidation of anilin by chromic acid and has the 
chemical formula CsHgOg. 

It occurs in long, dimorphous colorless crystals 
which are freely soluble in hot water, alcohol or ether; 
soluble in cold water in the proportion 1:20. The sub- 
stance has been recommended as an internal antiseptic 
and has apparently produced good results. It is usually 
administered in doses of from 1-2 to 5 grains. 

Hydrogen di oxid (Hydrogen Peeoxid). — This 
substance is sometimes described as "an aqueous solution 
of hydroxy]," thus HgOj or (OHjg. The solution used 
in practical medicine is of about "ten volume" strength. 
It has been lauded as a general disinfectant and germi- 
cide. It has one great advantage in that it is non- 
toxic. It seems to possess a special predilection for 
pus, which it destroys; this property is made use of in 
some cases for the diagnostication of the presence of 
pus where it may be concealed in cavities — its presence 
causes a marked effervescence when the peroxid is 
introduced. Shimwell, however, says that it is not ap- 
plicable to fresh wounds or fresh surfaces but to those 
that are septic in nature. It has lately been introduced 
into the U. S. Pharmacopeia of 1890. 

Surgeon-General Sternberg says that unless chemists 
can furnish stronger and more stable solutions of the 



156 

substance than they seem at present able to do, we are 
not likely to derive any practical benefit from its use as 
a disinfectant. Indeed its instability is marked and 
forms the chief objection, since one cannot rely upon 
all preparations unless assured of their freshness. The 
substance owes all of its virtues to the oxygen which it 
disengages when brought into contact with oxidizable 
matter. The action of oxygen and ozone are discussed 
under their proper headings, which see for furtiier in 
formation. 

Hydrofluoric Acid.— HF, This substance, which 
normally exists in a gaseous condition, has been sug- 
gested and used in the treatment of tuberculosis. The 
experiments of Chautard and Grancher with the sub- 
stance show that its direct and prolonged action dimin- 
ishes the virulence of the germ but fails to kill it. 
Hydrofluosilicic acid or its sodium salt (Sodic silico- 
fluorid, NagSiFg) have also been suggested and indeed 
were highly praised by Neudorfer, but, as Shimweil 
properly says, have now been discarded having no ad- 
vantage over boracic acid. Hydrochloric acid the con- 
gener of hydrofluoric acid is equal to sulphuric acid in 
germicidal power. 

Hydronaphthol. — This substance is derived from 
Beta-naphthol by the substitution of hydroxyl (OH) 
for an atom of hydrogen, hence the chemical formula 
would be CioH6(OH)2. It is soluble in water in the 
proportion of 1:900-1000. The drug has recently been 
suggested as a prophylactic in Ihe treatment of cholera 
or other infectious affection of the alimentarv tract. In 



15T 

the proportion of 1:400 it is said to possess powerful 
germicidal and inhibitory power. Its internal use is 
resorted to in doses of eight to ten grains three or four 
times a day, 

Indol.— Koch found that even an excess of this sub- 
stance in water did not destroy anthrax spores, even in 
eighty days. 

loDiN. — In 1853 Diiroy pointed out the fact that iodin 
possessed preservative properties, having a direct action 
upon pus and organized ferments; also that it caused 
aqueous solutions to keep indefinitely and that its syrups 
do not ferment. These facts and many other similar 
ones he embodied in a memoir presented to the Acade- 
my of Medicine of Paris in the year 1853. Velpeau 
again called the attention of the medical profession to 
the virtues of iodin in the year 1859; he said that it had 
been in use at that time for thirty years or more. 
Modern researches have corroborated the germicidal 
properties of both iodin and bromin. In such strength 
iodin is considerably stronger than bromin but less 
strong than chlorin, 

loDiN TriChlorid.— -ICI3 Behring claims that this 
substance, as an antisptic, has all of the potency of free 
chlorin or iodin \vithout their disadvantages. It is a 
yellowish-red powder with a peculiar and penetrating 
odor; it is soluble in water. Langenbuch found that it 
would restrain the development of bacteria, when added 
to nutrient gelatin, even when present in as small an 
amount as 1:1200, while 1:1000 would kill even spores 
in a short time, A solution with a strength of one per 



158 

cent destroyed anthrax spores suspended in water al- 
most instantly and a Yio P^^ cent solution effected the 
same result in a few minutes. Behring found that a 
one per cent solution would kill anthrax spores in blood- 
serum in forty minutes. 

Iodoform. — CHI3. Sometimes termed Tri-iodo me- 
thane. This substance is too familiar to need descrip- 
tion. The chief objection to it is its intolerable and al- 
most imperishable odor. The experiments of Tilanus, 
Neisser^ Buechner and others show that it is no germi- 
cide itself but has some antiseptic power; that is, it 
possesses inhibitory power, Neudoerfer says that it 
possesses toxic properties for some individuals, that 
^Hhey lose their appetites, become morose, absent- 
minded, and if the drug be continued there result phy- 
sical changes and death." 

Recent investigations have demonstrated that under 
certain conditions the substance does possess some 
germicidal power — that is, the decomposition of the sub- 
stance, accompanied by the liberation of free iodin 
gives it the antiseptic and germicidal properties which 
are peculiar to iodin. Sir Joseph Lister has recently 
called attention to the antiseptic properties of iodoform, 
claiming however, that the function of the iodoform 
was not to kill the germs but to destroy the products 
of their vital activity. This is certainly an extraordi- 
nary claim and a most valuable property, if experience 
can but demonstrate its truth. 

Iodoform is chiefly of value in various tubercular 
affections and remains the favorite remedy in such dis- 
eases. 



159 

Squibb says: "Its extremely disagreeable penetrating 
and persistent odor is still against it and deodorizers 
continue to be recommended from every quarter. It 
should be constantly borne in mind that the character- 
istic odor of iodoform is inherent to it and we might 
just as rationally expect to remove the sweetening prop- 
erty of sugar and still expect to retain the usefulness of 
that necessary article as to remove the odor of iodoform 
and retain its identity. We can adopt all manner of 
expedients to mask this objectionable quality, but we 
may rest assured that the iodoform is still there as long 
as we hold its combining elements together, and as soon 
as we split these up we no longer have this useful 
agent." 

loDOL— This substance, obtained by the action of an 
alcoholic solution of iodin upon pyrrol, and called Tetra 
iodo pyrrol^ has the chemical formula CJ^NH. It occurs 
in the form of a grayish-brown, odorless, tasteless 
powder; it is said to be yellowish and rather crystalline 
when pure. At elevated temperatures it decomposes, 
giving off vapors of iodin. It is soluble in alcohol and 
ether but almost entirely insoluble in water. It is 
claimed to be non-toxic and to possess the favorable 
qualities of iodoform in addition. Sternbirg (1885) as 
a result of his investigations stated that it was entirely 
without germicidal power. Riedlin also found that it 
had no effect upon even the spirilla of cholera, which 
are among the least resistant of all germs. 

loDOPHENiN. — Also termed lodo-phenacetin. This sub- 
sta nee is a combination of iodin and phenacetin and is 



160 

supposed to contain 50 per cent of the former substance. 
It is a brownish powder, but when pure exists as a crys- 
talline body with a characteristic iodin like odor and a 
burning taste. Like iodin it discolors the skin yellow. 
It is soluble in alcohol, glacial acetic acid and boiling 
hydrochloric acid. Most of the reports, with the ex- 
ception of those from the Paris Charity Pospital, are 
against the drug. Seibel says that it gives off iodin in 
excess too readily and that it possesses no advantage 
over free iodin itself. This observation has been con- 
firmed and corroborated by other investigators also. 

loDozoNE.™ This is the name given by Robin to a 
solution of iodin in ozone. The solution has all of the 
appearance of a complete one and gives no reactions by 
means of which a different condition can be detected. 
This was first suggested by the well known value of 
sea-air whose virtues were supposed by some to be due 
to ozone and traces of iodin. lodozone is recommended 
as a spray in tuberculosis pulmonalis and open wounds 
—rather lodozone was recommended in such cases, for 
it appears now to have utterly gone out of existence as 
a pharmaceutical or remedial preparation. 

IzAL.- — This is a trade name for an emulsion contain- 
ing thirty per cent of a new oil which it is claimed is 
produced by a patent process used lot the manufacture 
of a special variety of coke. Squibb says that: "It 
appears to belong to a series analogous to the terpenes, 
with characteristics between those of the paraffins and 
the benzins. No phenol proper can be detected in the 
emulsion." It has not gone beyond the land of its birth 



161 

(EDgland) as yet. It is claimed that it is a powerful 
antiseptic, that it does not injure the hands, that it has 
no objectionable smell, that it is non-toxic and in fact 
altogether valuable. This is based entirely upon the 
reports of a few enthusiasts, it is entirely too early to 
place any definite value, or lack of value, upon it as 
yet. Time will demonstrate its advantages, whatever 
they may be. 

Lactic Acid. — HCsHsO,, The second member of a 
group of monobasic, di-atomic acids. It is a colorless 
syrupy liquid of strongly acid properties, mixing with 
water and alcohol in all proportions; it occurs in many 
plant juices, either free or combined. It is also pro- 
duced by the fermentation or ^'souring" of milk. 

Kitasato found that a .4 per cent solution would de- 
stroy the typhoid bacillus in five hours while a 3. per 
cent would do the same in the case cholera spirilla in 
the same length of time. 

Lanolin. — This substance is a fat extracted from 
sheep's wool and containing about thirty per cent of 
water — whence its name of Adeps lance hydrosus. It is 
a white odorless substance which does not affect litmus 
and is used as a base for many ointments or prepara- 
tions used in the local treatment of diseases of the skin, 
etc. It is insoluble in water, partly soluble in alcohol 
and readily so in ether, acetone and benzene. 

Gottstein found that various organisms ceased to 
grow after contact with pure lanolin from five to seven 
days; hence it appears to possess inhibitory powers. It 
is one of the best ointment bases known to pharmaceu- 
tical science. 



162 

Lead Chlorid. — PbClj. This substance is not in 
common or general use but Miquel has determined that 
it is antiseptic in the proportion of 1:500. 

Lead Nitrate — Pb(N08)2. This substance is fre- 
quently credited with germicidal properties which it 
does not really pospess. Miquel has determined that it 
is antiseptic in the proportion of 1:277. 

LosoPHAN. — Tri-iodo-meta-cresoL This substance is 
a new antiseptic produced by the action of iodin upon 
;;/-oxytoluic acid. It occurs in the form of colorless, 
needle-like crystals containing about eighty per cent of 
iodin. It decomposes readily in dilute solutions of al- 
cohol, but not in solutions containing seventy -live per 
cent of alcohol. Its use is, as yet, restricted almost en- 
tirely to dermatology. 

Lysol. — This substance is the saponified product of 
coal-tar; it is obtained from tar-oils by boiling with 
alkalies and fats and contains about fifty per cent of 
cresols. It occurs as a clear, brown, oily liquid slightly 
lighter than water and with an aromatic odor like that 
of creosote. It is soluble in alcohol, chloroform, water, 
glycerin, carbon di-sulphid and benzin. Experience has 
not justified the extraordinary claims which have been 
made for it. Its soapy nature renders instruments or 
objects immersed in solutions of the substance disagree 
ably and dangerously slippery. 

Cadeac and Guinard, after elaborate experimentation 
with the substance, have concluded that while it is an 
undoubted microbicide it has no advantage over the 
antiseptics of established reputation; that it is only effi- 
cacious in solutions sufficiently strong to prove irritat 



163 

iDg or caustic and that its sphere of usefulness will not 
extend beyond the disinfection of stools, privies, ships, 
stables, etc., aiding thus in the prophylaxis, prevention 
and arrest of epidemics. It is used by some locally in 
solutions of strengths of from three to five per cent. 

Malic Acid. — Has about the same germicidal value 
as citric acid. 

Mercury. — The various soluble salts of this metal 
seem all to have more or less antiseptic activity al- 
though the fallacious belief in their unsurpassed gertnu 
cidal powers has been entirely exploded by the results 
attained by recent investigators. The succinate, the 
phenylate, the salicylate, the thymol-acetate, the thymo- 
late, the iodid, the cyanid and a host of others have 
their respective adherents. None of them however 
have attained the eminence of the so-called "bi chlo' 
ride." Mercuric iodid however is but slightly inferior 
to this chlorid; it is moreover, more stable, less toxic 
and altogether more agreeable. According to Lister, 
until his recent declaration in favor of carbolic acid 
above all other germicides, the double cyanid of mer- 
cury and zinc more nearly accorded to the requisites of 
an ideal antiseptic. This substance is non-volatile, non- 
irritant, insoluble to the extent that wound secretion 
does not wash it out of the dressing; its great disad- 
vantage, however, is its feeble germicidal power which 
is almost balanced though by its inhibitory power. 
(See Corrosive Sublimate). 

Methylene Blue. — This 8?iV><tanc^^ is ofu^ of the 
auilin d^esj beiug called Tetra-methyl-lhioniH. The 



164 

drug is usually found as a bluish powder composed of 
scaly crystals of a bronze like tinge; it is somewhat 
soluble in water and more so in alcohol. It has been 
recommended especially as an antiperiodic, particularly 
where quinine has failed. It has also been used locally 
in diphtheria. (See Anilin Dyes). 

MiCROCiDiN. — This name is applied to a mixture of 
beta-naphthol and sodic hydroxid — it is presumably 
termed sodic naphtholate. It is a white powder soluble 
in water in the proportion of 1:3. It is employed as an 
antiseptic both internally and externally. When used 
locally it is employed in the strength of from three to 
five parts to the thousand. It is but little heard of now, 
although Cozzolini of Naples thinks that it has given 
him excellent results in suppurations of the ear and in 
inflammatory conditions of the nose and throat. 

Mono chlor-phknol (see Chlor-phenol). 

Morphia Hydrochlorate. — This substance has fee- 
ble inhibitory powers. Miquel has decided that it is 
antiseptic in the proportion of 1:13. 

Naphthalene. — Also termed Naphthalin^ having a 
chemical ^formula of CioHg. It is a hydrocarbon ob- 
tained from coal-tar; it is also formed in the manu- 
facture of ordinary illuminating gas. As usually found 
it occurs as a grayish white substance either in powder 
or brilliant, scaly crystals which have an odor of coal- 
tar and an aromatic bitter taste. It is soluble in alcohol 
ether, the fixed and volatile oils and in acetic acid, but 
insoluble in water. Is is also sold in molded blocks 
uiider the name of JLlabastrinH and Camphylem and 



165 

used for preserving furs and flannels from moths and 
also in urinals for purposes of disinfection. It is claimed 
that the inhalation of the vapor of the substance has 
given good results in the treatment of pertussis, etc. 

Naphthol. — Also termed Naphthyl alcohol zxidi Iso- or 
Beta-naphthoL It may be obtained by the action of sul- 
phuric acid for some time upon naphthalene. The 
chemical formula is C10H7OH. It occurs in brilliant, 
colorless, shining, crystalline laminsB having an odor 
resembling that of phenol, with a slight burning taste. 
It ig readily soluble in alcohol, ether, chloroform, ben- 
zene and the fatty oils; it is fairly soluble in hot water 
but almost insoluble in cold water. It is used as an 
antiseptic in cutaneous diseases and affections of the 
respiratory tract, also as an intestinal antiseptic, Foote 
says that the substance exercises some germicidal power 
even in the proportion of 1:2300 but concludes that a 
saturated aqueous solution (1:1150) does not equal the 
action of one per cent solution of carbolic acid or of 
creolin. 

It has been used internally in the dose of two to fif- 
teen grains and ezternally in solutions or ointments of 
the strength of from 2 to 10 per cent. 

There are a great number of derivatives of naphthol 
such as iodo-beta naphthol, benzo-naphthol, microcidin, 
naphthol camphor, etc. It is undoubtedly an efficient 
antiseptic, as indeed are many of its derivatives, but, as 
Squibb says, "Naphthol and all its derivatives cannot be 
said to have superseded carbolic acid, although they no 



166 

doubt will find a permanent place on the list of valuable 
agents." 

Nitric Acid. — HNO,. This substance is too well 
known to need description. Nitric, hydrochloric and 
sulphuric acids are approximately of the same germici- 
dal strengths. (See sulphuric acid). 

Nitrous Acid. — HNOj. Nitrous acid represents the 
first degree of reduction or de-oxidation of nitric acid. 
Sternberg (1880) determined that the activity of dry 
vaccine virus was destroyed when exposed upon ivory 
points for six hours to the action of an atmosphere con- 
taining one per cent of nitrous acid. 

Oil of Mustard. — The presence of this substance in 
the proportion of 1:33000 is sufficient to prevent the 
development of anthrax spores, though so weak a prepara- 
tion does not kill them. 

Oil of Turpentine. — Koch found that though oil of 
turpentine failed to destroy the spores of anthrax in one 
day they were destroyed by such exposure for five days; 
he found also that their development was effectually 
prevented by the presence of the substance in the pro- 
portion of 1:75000. Christmas, in his experiments upon 
the pus cocci, says that an excess of oil of turpentine ad- 
dad to liquefied gelatin cultures of the Staphylococcus 
pyogenes aureus was unable to destroy the micrococci even 
in eight hours. 

Oleic Acid.— HCigHagOa. Oleic acid is a constituent 
of most facts, especially oily fats— olive oil for instance 
being almost entirely an oleate of glyceryl. The ex- 
periments of Koch seem to indicate that the substance 



167 

has little if any antiseptic power. A five per cent solu- 
tion in ether failed to destroy anthrax spores in five 
days. 

Oliye Oil. — This substance, as has been stated, is 
almost entirely, when pure, glyceryl oleate. Koch has 
determined that anthrax spores germinate even after 
ninety days immersion in this substance; indicating an 
apparent absence of any germicidal action whatsoever. 

OsMic Acid. — HjOsO^. Koch has determined that 
this substance will kill anthrax spores in twenty-four 
hours if present in the strength of one per cent. Miquel 
has determined that the substance is antiseptic in the 
proportion of l:6QQ6, 

Oxalic Acid. — HgCgO^. Kitasato has determined 
that this substance, in the strength of .36 per cent, will 
destroy typhoid bacilli in five hours and that a solution 
of the strength of .28 per cent will kill cholera spirilla 
in the same time. 

Oxygen. — This element exists in two conditions — one 
the free and normal element whose molecule is ex- 
pressed by the symbol O^ and the other, an allotropic 
modification,termed ozone whose molecule is represented 
by the symbol Oj. Free oxygen is necessary for the 
development of a large number of species of bacteria— 
indeed it is essential to all aerobic species; on the other 
hand it completely prevents the growth and develop- 
ment of the anaerobic species. 

Oxygen has no great power of destruction of bacteria 
unless nascent — that is, freshly generated. The common 
belief is that all oxygen under all conditions is possessed 



168 

of mar^elous^powers over germ life — such is^ not alto- 
gether the case. Indeed, as we have said, the presence 
of oxygen so far from being restrictive is absolutely 
necessary for the development and growth of all aerobic 
species. Nascent oxygen, on the other hand, is a po- 
tent agent — indeed it is to the virtues of the element 
generated in this peculiar condition that potassic 
permanganate, and other oxy-antiseptic substances 
owe their entire antiseptic powers. Duclaux says that 
oxygen has the power of destroying bacteria but that it 
is exceedingly difficult to make an application of the 
substance to man except in the form of ''oxygenated 
water" (it is thus that he designates hydrogen peroxid) 
which, as he says, has not always given the most happy 
results to those using it. Indeed although hydrogen 
peroxid is a valuable antiseptic and deodorant its germ- 
icidal value is highly overestimated. 

Ozone. — It was formerly supposed that this allotropic 
modification of oxygen would prove to be a valuable an- 
tiseptic agent but unfortunately for its reputation in this 
respect recent experiments show that it does not possess 
the anticipated activity — indeed that it possesses little 
value from a practical standpoint. 

Lukaschewitsch found that one gramme in the space 
of a cubic metre utterly failed to kill anthrax spores 
even in twenty -four hours. So much for its vaunted 
activity. Then also, Sonntag, Friedlaender, Nissen and 
others secured negative results in their experiments 
upon the germicidal activity of this substance. So far 
from being the valuable agent previously supposed, a 



169 

careful consideration of all of the experimental data 
leads one to the conclusion that, as a germicide, ozone 
is utterly devoid of practical value in therapeutics and 
disinfection. It is possible that the splitting up of a 
molecule of ozone may yield us either nascent oxygen 
or else a mixture of molecular and nascent oxygen, thus: 

Os = O, + O 
in this case whatever germicidal action may ensue is 
due not to the ozone, for it has been destroyed the 
moment that the molecule Og has been decomposed, but 
to the nascent oxygen set free. Ozone then v^ould have 
less virtue than any of the various processes by means 
of which nascent oxygen itself is generated. 

Paracresolal. — This substance, also called Cresalol^ 
is paraoresolic salicylate and is represented by the 
chemical formula CeH^.OH.COO.CeH^CH,. It occurs 
as a whitish crystalline powder with an odor like that of 
salol, it is insoluble in water but slightly soluble in alco- 
hol. This substance, which is strongly analogous to 
salol (phenylic salicylate) in its therapeutic functions, is 
used more largelv, as is salol, as an intestinal antiseptic 
in doses of from three to thirty grains /^r diem. 

Phenol. — (See carbolic acid). 

Phenocoll. — This substance is also termed Amido- 
para-acet-phenetidin. It has been more largely used, 
not only itself but also in the form of the hydrochlo- 
rate or hydrochlorid and salicylate (SalocoU), as an an- 
tipyretic. The acetate and carbonate have also been 
used for this same purpose. Certain investigators have 
called the attention of the medical profession to the an- 



170 

tiseptic value of the substance. Dr. Beck of New York 
conducted experiments with a view to determining the 
exact value of such properties of the substance. He 
found that phenocoU excelled phenacetin, acetanilid, and 
iodol in such activity and indeed even excelled iodoform 
to which he considered it superior otherwise on account 
of the ready solubility of phenocoll, its freedom from 
odor and irritating properties and its freedom from 
toxic properties. The substance occurs as a white crys- 
talline powder readily soluble in water or alcohol but 
very sparingly soluble in benzol, chloroform or ether. 

Phenolid. — A 50 per cent mixture of acetanilid and 
sodicbi-carbonate; it seems to have passed entirely from 
use. 

Phbno-Salyl. — This substance is not a definite com- 
pound but a mixture of four or five substances. The 
formula is as follows: 

Carbolic acid, about - - 9 parts. 
Lactic acid, " - - 2 parts. 

Salicylic acid, " - - 1 part. 

Menthol, " - - 7io part. 

The menthol is added to the combined acids which 
are heated up to the point of liquefaction. The mixture 
is said to be soluble in water to the extent of making a 
4 per cent solution. The formula has been somewhat 
extended by the addition of eucalyptol to the other in- 
gredients; this is mixed in small quantity along with 
the menthol and then the whole resulting mixture is 
mixed with four times its volume of glycerin. The 
formula was introduced by Dr. Christmas after some 



171 

experiraentation at Pif^teur's Institute in Paris. Dulerly 
reports its sucee8i*f ul use in various uterine affectionn, 
in gonorrhea and as a wash for rectal sores and ulcera- 
tions. Tersin claims that it is especially effective 
against the bacillus of anthrax — indeed he gives it high 
antiseptic power which, if present at all, mu«t be due to 
the large amount of carbolic acid (about 75%) present 
in the mixture; it must however be inferior to carbolic 
acid when combined, as has been suggested, with other 
acids of higher activity, such as hydrochloric orboracic 
acids — indeed in the latter case an excellent substance 
results. The latter fact has at last been properly ap- 
preciated and a combination of carbolic and boracic 
acids has been put upon the market under the name of 
Sennine — named after Senn, who has done so much for 
the advancement of antiseptic principles in American 
surgery. For a full description of this substance see 
the article Sennine under its proper and appropriate 
heading. Because of the introduction of such superior 
and more valuable compounds Pheno salyl and analo- 
gous substances are passing out of general use — indeed 
Pheno-salyl has already done so according to Squibb. 

Phosphoric Acid — H3PO4. This substance, the or- 
dinary Iri-basic or ortho phosphoric acid, hardly needs 
description. Kitasato hss conducted experiments with 
a view to a determination of the germicidal activity of 
the substance, using an acid which contained 152 milli- 
grams of acid per cubic centimetre. A solution contain- 
ing three-tenths of one per cent (.3%)of this prepara- 
tion destroyed typhoid bacilli in from four to five hours 



172 

while a solution of .183 per cent strength (that is, slight- 
ly more than one-half as strong) killed the spirilla of 
cholera in the same time. 

PiCROL.— This substance is Di-iodo-resorcin-mono- 
sulphonic acid. It is a new antiseptic, said to contain 
aboubt 52 per cent of iodin, and is described by Darzens 
and Dubois as possessing great potency. It is prepared 
by adding, while constantly stirring, an alcoholic solu- 
tion of iodic acid and iodin to resorcinmono sulphonic 
acid, produced by the action of concentrated sulphuric 
acid upon resorcin. The potassium salt of this sub- 
stance is usually described as existing in the form of 
colorless, odorless crystals with an exceedingly bitter 
taste. These crystals are readily soluble in water and 
the ordinary solvents. It is usually considered non- 
toxic but its reckless use is not without danger. It is 
too soon to express an opinion on the status or value of 
the substance as no clinical reports of its use have been 
collaborated as yet. 

PiPERONAL. — CgHeOs. This substance is also termed 
Heliotropin and is obtained from piperic acid by oxida- 
tion. It usually occurs in the form of white and scaly 
crystals which are soluble in alcohol and ether but are 
insoluble in water. At present the substance is more 
generally employed in the arts, in the manufacture of 
perfumes, though its use as an antipyretic and antisep- 
tic has been suggested; such use has been largely re- 
stricted by the exceedingly high price of the substance. 
When administered it is usually given in single doses of 
about fifteen "grains. 



It3 

PoTAssic Acetate. — KCjHgOg. This substance is 
the potassium salt of acetic acid, analogous to plumbic 
acetate ("Sugar of Lead") which is the lead salt of the 
self-same acid. It is hardly necessary to describe its 
chemical and physical properties. Suffice it to say that 
Koch found that a saturated solution of the salt in water 
failed to kill anthrax spores in ten days. 

PoTAssic Arsenite.— This substance, or rather the 
potassic hydrogen arsenite which has the chemical for. 
mula KHAsOs, is used in medicine under the name of 
"Fowler's Solution." It is an acid potassium salt of 
arsenous acid. The substance has been found to pos 
sess absolutely no germicidal action. It may be slight- 
ly antiseptic however for Miquel has determined that it 
is so in the proportion of 1:8. 

Potassic Di-Chromate. — KaCrjOy. This substance, 
which exists in beautiful yellowish-red crystals, was 
supposed to possess active germicidal properties but the 
experiments of Koch demonstrate that a five per cent 
solution failed to destroy anthrax spores even after two 
days exposure. Miquel has determined, however, that 
it is antiseptic in the proportion of 1:909. 

Potassic Bromid. — KBr. This substance is more 
familiarly known and used as a nerve sedative or a 
hypnotic but Kitasato has proven that it also possesses 
antiseptic and indeed even germicidal properties. He 
found that when typhoid bacilli and cholera spirilla 
were immersed in a solution containing from 9 to 10.6 
per cent of potassic bromid they failed to grow. Indeed 
they were killed when exposed for four or five hours to 



It4 

the action of solutions with strengths of 10-12 percent. 

PoTAssic Carbonate. — K2CO3. Kitasato has also 
proven the antiseptic and germicidal action of this sub- 
stance. He found that the development of typhoid and 
cholera germs was prevented by solutions containing 
as small an amount as .74- 81 per cent and indeed even 
killed by five hours exposure to the action of a one per 
cent solution. 

PoTASsic Chlorate. — KCIO3. This substance is 
probably more familiarly known to many of us as chlo- 
rate of potash, in common use for the treatment of the 
various inflammatory conditions of the naso-pharynx. 
Its efficacy in such affections together with their fre- 
quent micro-organic nature led many to suspect that the 
drug had a specific action which was due, it was thought, 
to a specific action of the substance upon the germ di- 
rectly. Contrary to the general belief, the substance is 
devoid of any germicidal power. A careful considera- 
tion of the experimental data now at our disposal forces 
this conclusion upon us Sternberg found that a four 
per cent solution failed to destroy or kill the MicrocoC' 
cus Pasteuri even after an exposure of two hours to its 
action. Koch also found that a five per cent solution 
failed to kill anthrax spores in five days. 

PoTAssic Chromate. — K2Cr04. This substance is 
apparently no stronger than the chlorate of potassium, 
for Koeh found that a five per cent solution failed to 
kill anthrax spores in five days, as was the case with the 
chlorate. 

PoTASSic Cyanid. — K (CN). This substance seems 



175 

to possess little or no germicidal power— indeed Miquel 
gives it the same power in this respect as potassic di- 
chromate, that is it is antiseptic in the proportion of 
1:909 

Potassic Hfdroxid. — KOH, This substance is more 
familiar to many, especially those who studied Chemis- 
try when the old system of nomenclature was in vogue, 
as "caustic potash" or as potassium hydrate. Sternberg 
demonstrated that while an eight per cent solution was 
unable to destroy the pus cocci in two hours a ten per 
cent solution of the same substance was able to effect 
this result in the same time. Kitasato found that an .18 
per cent solution would kill the typhoid bacillus in from 
four to five hours while a .237 per cent solution was re- 
quired to effect the same result in the same time with chol- 
era spirilla. This fact presents a curious and interesting 
condition. Usually the spirilla of cholera are less resist- 
ant than the bacilli of typhoid fever but here we have 
the reverse true; as a rule the cholera germ is especially 
susceptible to the action of acid antiseptic solutions. In 
this case we have an alkaline substance and the spirilla 
are less susceptible to its influence than the typhoid 
bacilli. 

Potassic Iodid. — KI. This substance, more com- 
monly called iodide of potash, is used frequently in the 
treatment of certain stages of syphilis and also of rheu- 
matism, etc. It has been determined that it possesses 
slight germicidal properties though these are not present 
to a marked extent. Koch demonstrated that a five per 
cent solution failed to destry anthrax spores in eighty 



176 

days. The typhoid bacilli and the cholera spirilla fail 
to grow in an eight per cent solution, but are destroyed 
by five hours exposure to a 9.23 per cent solution. Miquel 
has determined that it is antiseptic in the proportion of 
1:7, a very low power. 

FoTASsic Permanganate. — KMnO^, or in the older 
system KjMnaOg. The experiments of Jaeger show 
that a one per cent solution is not reliable for the de- 
struction of pathogenic bacteria but that a five per cent 
solution is very effectual, although it does not kill the 
bacillus of tuberculosis. Miquel has determined that it 
is antiseptic in the proportion of 1:285. 

The experiments of Kelly, Welch, Robb, Ghriskey 
and others, at the Johns Hopkins University, upon the 
various cocci and the germs usually found upon the 
hands and beneath the nails of physicians and surgeons, 
indicate that exposure of the hands to the action of a 
saturated aqueous solution of the substance with a 
further bath in a saturated aqueous solution of oxalic 
acid to remove the stain of the permanganate and to re- 
inforce its germicidal action was by far the most effic- 
ient means of sterilization of the hands — especially if 
preceded by a thorough scrubbing of the hands and 
nails with brush, warm water and common soap. They 
found by rigid experiment that this was far superior to 
the action of corrosive sublimate as used in Fuerbring- 
er's method, so commonly resorted to in obstetrical and 
surgical practice for the sterilization of the hands of 
the operator. Many operators of advanced opinions are 



177 

now adopting the permanganate method so highly fa 
vored by Kelly. 

Pyoktanin.— This is a name patented by Merck for 
the two anilin dyes more commonly known as methyl- 
violety or yellow pyoktanin, and methyl-blue or blue 
pyoktanin. The substance occurs as an odorless pow- 
der which is soluble in alcohol and soluble in seventy- 
five parts of hot and fifty parts of cold water. This 
substance has had remarkable exaltations and damna- 
tions in its short career as an antiseptic. (See Anilin 
dyes). Certain oculists and laryngologists have claimed 
to obtain benefit from its use. Roswell Park and others 
say that its use is disappointing if not entirely worth- 
less, which latter term he thinks more nearly describes 
the value of the medicament. Dr. Doering claims very 
favorable results from its local use in diphtheria. Gold- 
schmidt has pronounced it useless in Lepra tuberosa, 
N. S. Roberts says that "it is of much less value than 
the standard remedies now in use, but is worth thinking 
of when these fail." 

It has the great disadvantage of highly coloring the 
skin or clothing, being an anilin dye and having all of 
the intense coloring power peculiar to that class of sub 
stances. It not only stains the ska and clothing but 
the dressings and the hands of iiie operator himself. 
This produces exceedingly di^agreiable results. More- 
over, prolonged contact with certain of the anilin dyes 
has been productive of varioi s eczematous conditions 
of the skin. 

Pyrozonb. — This is a name given by iti manufacturer 



178 

to a preparation of a concentrated solution of hydrogen 
peroxide in ether. It is claimed that it contains about 
fifty per cent of the peroxid; it seems to be an efficient 
agent as far as hydrogen peroxid can be, having all of 
the properties of that substance which is its active 
principle. 

QuiCKiNE.— A trivial, silly and senseless name for 
what the manufacturer terms **the new antiseptic, anti- 
pyretic and antizymotic," When we consider the 
formula it puzzles one to discern how even the wildest 
of dreams could ascribe antipyretic properties to the 
substance. According to the Pharmaceutische Zeiiung^ 
Quickine consists of one part of corrosive sublimate, 
fifty of carbolic acid and fifty two of dilute alcohol. It 
consists, according to Squibb, of one part of pure car- 
bolic acid, two-hundredtbs of a part of corrosive chlorid 
of mercury and one-thousandth of a part of a mixture of 
alcohol and water. All of this, as Squibb satirically 
quotes, is manufactured by a process of "dynamization 
and potentialization that guarantees to the medical pro- 
fession the absolute accuracy and uniformity" of the 
product — or rather mixture. That it has met with little 
or no success is shown by the fact that in spite of the 
adoption of catch-penny methods it has been relegated 
to innocuous desuetude. Whatever of virtue the sub- 
stance possessed was due to the presence of carbolic 
acid and corrosive sublimate; these virtues were no 
greater than those attained by the use of the substances 
themselves. Hence, having no claim to attention, the 
mixture has died a death of inanition. 



1?9 

Quinine. — This alkaloid andit^ salts are too familiar 
to ihe phyBician to need description. These substances, 
although possessing no marked germicidal power, are 
yet somewhat antiseptic. The experiments of Arloing, 
Cornevin and Thomas have proven that the sulphate, 
in ten per cent solution, does not destroy the bacilli of 
symptomactic anthrax. Sternberg found that the sul- 
phate, in the proportion 1:800, while it did not destroy 
various micrococci and bacilli upon which he experi- 
mented, yet had the power of preyenting their develop 
ment — that is, in such proportion it was antiseptic but not 
germicidal. Miquel has determined that the hydrobro- 
mate is antiseptic in the proportion 1:182 and Ceri has 
determined that the hydrochlorate is antiseptic in the 
proportion of 1:900 — that is, its antiseptic power is 
greater than that of the hydrobromate. 

Resopyrin. — This substance M. Portes describes as 
a compound resulting from the mixture of resorcin and 
antipyrin in solution in the proportion of their chemical 
equivalents. It occurs in oblique, colorless crystals 
which are usually of a rhombic and prismatic structure; 
it is soluble in alcohol but insoluble in water. 

The substance has been known for several years but 
has now practically passed out of use. 

Resorcin. — CeH4(OH)2. This substance is also 
termed Meta-di-hydroxy-benzene^ Meta-di-oxy -benzene 
and ResorcinoL As the chemical formula indicates, it is 
a di-atomic phenol. It may be produced synthetically 
from benzene but is also made by fusing different res- 
ins, such as those of asafetida, galbanum, etc», with the 



1^0 

fixed or caustic alkalies. Resorcin is a yellowish or 
white, flocculent or crystalline powder with a somewhat 
sweetish and pungent taste and a slightly aromatic odor 
somewhat resembling that of normal fresh urine. It is 
soluble in about its own weight of water; it is also solu- 
ble in alcohol and ether but very sparingly soluble in 
chloroform, carbon di-sulphid or benzene. Resorcin is 
used to some extent in the arts in the manufacture of 
certain dyes. 

Resorcin is said to possess antiseptic properties and 
on that account is of use in the treatment of various 
diseases of the stomach and intestinal tract. Its use 
has been recommended in dysentery, cholera infantum, 
gastric ulcer, gastritis, diphtheria and affections of the 
larynx, pertussis and also, by Unna, in acne rosacea. 
For local use, solutions of 1-3 per cent may be used, or 
ointments of 5-10 per cent, or even in some cases as 
high as 25 per cent may be exhibited. When used in- 
ternally resorcin is usually administered in doses of one 
or two grains. 

Retinol. — CsgHie. This substance, also termed Resi- 
nol and Rosinol^ is obtained by the distillation of 
Burgundy pitch, or pine-resin. It occurs as a thick, 
oily and yellowish liquid, slightly lighter than water. 
It is said to be a good antiseptic; it is used chiefly as a 
solvent for various drugs, such as salol, aristol, iodol, 
creosote, carbolic acid, camphor, cocaine and other simi- 
lar bodies; indeed the effects of such medicaments are 
often enhanced by the antiseptic properties of the reti- 
nol used as the vehicle. 



181 

Desnos, a French observer, has reported very gratify- 
ing results from the use of solutions of 5-10 per cent of 
salol in retinol in certain cases of sub-acute cystitis. 
He has claimed that it frequently affords prompt relief 
even after other agents have failed. The peculiarity of 
the solution is, it is said, that it will remain in the blad- 
der even after from six to eight distinct acts of micturi- 
tion — of course in such case there is a diminution in 
quantity after each urination but all is not voided at 
one act. When used locally retinol may be applied m 
substance or in ointment; internally it is administered 
in doses of about one grain. 

Saccharin. — C6H4.CO.SO2NH. This substance is al- 
so termed Gluside^ Glucusimide^ Benzoic sulphinide, Ben- 
zoyl-sulphonic-imide and Anhydro-ortho-stdphamine--h en- 
zoic acid. Saccharin is a derivative of benzoic acid the- 
oretically; practically however it is produced from 
toluol by a series of complicated synthetical processes. 

Saccharin occurs as a white, amorphous or somewhat 
crystalline powder with an intensely saccharine or sweet 
taste followed by a slightly bitter after-taste and has a 
slight odor of bitter almonds — this odor becomes more 
prononnced upon heating the substance. It is soluble 
in alcohol and ether, also in glycerin, dilute ammonic 
hydroxid and in an aqueous solution of sodic bi-carbon- 
ate. It is only sparingly soluble in water— one part dis- 
solving in about 230 of water; this solution is intensely 
sweet and is somewhat acid in reaction. The intense 
sweetening power of saccharin is its chief characteristic — 
it is even perceptible when saccharin is dissolved in YO,- 



1§2 

000 parts of water, being nearly three hundred (280) 
times sweeter than ordinary cane sugar. It is employed 
as a sweetening agent in diabetes where the use of sugar 
is interdicted. It is also a good antiseptic and is said to 
have given marked benefit in the treatment of cystitis. 
It has also been used as a vehicle to mask the taste of 
intensely bitter remedial agents. 

Saccharin may be used either locally or internally; 
the dose is said to be indefinite. 

Salaoetol.— Also termed Salicyl-acetoL This is a 
new synthetic product obtained by Fritsch by the de- 
composition of sodic salicylate by means of mono chlor- 
acetone, while heat is applied. It has been proposed, 
like salophen, as a substitute for salol. It occurs in fine 
acicular crystals or scales with a slightly bitter taste. 
Salacetol is but sparingly soluble in cold water, but 
freely so in hot alcohol and the other various ordinary 
solvents. 

It has been used by Bourget of Switzerland in doses 
of 30-45 grains in incipient diarrhea and choleraic 
affections. It has also said to have given good results 
in gout, sub-acute rheumatism and various genito- 
urinary affections. 

It is too soon however to express a positive opinion as 
to its value or its probable status in therapeutics. 

Salicylamid.— CeH^.OH.CO.NHj. This substance is 
an amido compound or derivative of salicylic acid; it 
was first prepared by Limpricht by treating oil of win- 
tergreen with saturated ammonic hydroxid, it has since 
been prepared by the action of the latter substance upon 



183 

methyl salicylate (the artificial oil of wintergreen), or 
by the action of heat upon amnionic salicylate. Salicyl- 
amid usually occurs in the form of colorless, thin, trans- 
parent laminar crystals, which are tasteless, leaving a 
sensation of grittiness in the mouth. It is soluble in 
alcohol, ether and chloroform; in water it is soluble in 
the proportion of 1:250 

It has been recommended as a substitute for salicylic 
acid, and it is said to have several advantages over the 
latter drug, being tasteless, more soluble, more prompt 
and powerful in action and possessing greater analgesic 
power. It has also germicidal powers similar to those 
of salicylic acid. It is claimed that it has been used 
with good results in tonsillitis, chronic rheumatism, 
ovarian pains, neuralgia, etc. When used internally, 
about fifteen grains are administered per diem^ in doses 
of from three to five grains each. 

Salicylic Acid. — CeH^.OH.COOH. This substance 
has been known to chemists for some time, but its intro- 
duction into medicine has been comparatively recent. 
Kolbe found that it could be prepared by treating a 
solution of carbolic acid in sodic hydroxid with carbon 
dioxid at a moderate degree of temperature. It may 
also be obtained by fusing potassic hydroxid with sali- 
cin, the latter substance being a glucoside found in 
willow bark. Salicylic acid occurs in several species 
of violet; it also exists as the methyl salt in oil of 
wintergreen. It is usually sold as a dull white powder, 
or in long acicular crystals; it has usually a peculiar 
aromatic and pungent odor^, and a peculiar sweetish yet 



184 

acrid or acidulous taste, which, as Wood says, is accom- 
panied by a transient sense of numbness. Salicylic 
acid is readily soluble in hot water, alcohol, ether etc., 
and but sparingly soluble in cold water and glycerine. 
It is irritant to mucous or fresh wound surfaces. 

The drug is usually described as non-toxic, but 
Quincke, Ogston, Empis, Gubler and Dixneuf, as well as 
others, have reported cases of death from the substance 
— indeed, in one case reported, death ensued as a result 
of the administration of forty eight grains in four hours. 
The acid has the peculiar property of macerating flesh, 
and in this way sometimes attacks the hands when used 
as an antiseptic — it is owing to this peculiar property 
that salicylic acid is an almost constant ingredient of 
the various forms of "corn salves." It is also readily 
absorbed and is eliminated largely by the kidneys and 
hence is found in the urine. 

Kolbe found that the presence of .04% had great in- 
fluence in preventing the souring of milk; on account of 
this property it is widely used in beer, and in perishable 
food products, to prevent fermentation and decomposi- 
tion, although such use has been forbidden in some coun- 
tries. Sternberg found that a two per cent, solution 
destroyed pus cocci in two hours. Abbott found that 
micrococci were destroyed by a solution of the strength 
1:400. Kitasato found that 1.6% destroyed typhoid 
bacilli in five hours, and that 1.3% produced the same 
effect in the same time upon cholera spirilla. A four 
per cent, solution however failed to affect the organisms 
of broken-down beef solution, KoGh|algo found that a 



185 

five per cent, alcoholic solution failed to destroy the 
spores of anthrax. Miquel has determined that the 
substance is antiseptic in the proportion 1:1000. 

The substance was introduced into surgery by Thiersch, 
of Leipzig, as a substitute for carbolic acid; it was 
then thought to possess as much germicidal efficiency as 
carbolic acid, but experience has failed to demonstate 
this, moreover it is irritant. As Wood says in his 
classic work upon Materia Medica and Therapeutics, 
"There can be no doubt that salicylic acid is capable 
of accomplishing much in antiseptic surgery, but it does 
not seem to be replacing carbolic acid^ as it at one time bid 
fair to do. Its freedom from odor and comparative free- 
dom from poisonous and irritant (?) properties are cer- 
tainly strong recommendations in its favor; neverthe- 
less, carbolic acid is more generally employed, and Mr. 
Callender, after twelve months' trial in the wards of St. 
Bartholomew's Hospital, has formerly condemned sali- 
cylic acid as much inferior to carbolic acid." 

It can be used dry with good effect, but it does not 
adhere firmly to the parts, and therefore in the presence 
of free secretion it is washed away, leaving the wound 
surface exposed to infection. In acid diarrheas and 
fermentative conditions of the intestinal tract it owes 
its chief value to its restraining and inhibitory in- 
fluence upon the development and vital activity of the 
various micro-organisms to which the acid intestinal 
fermentation is due, rather than to direct germicidal 
action. 

The sodium salt of the acid, sodic salicylate, is said 



to be a feeble antiseptic and hardly worthy of the 
name. Indeed all of the salicylates have much less 
power than the free acid. 

Salocoll. — This is but the trade name for the salicy- 
late of phenocoll; it is claimed to be more advantageous 
than the bydrochlorate, being less soluble and therefore 
freer from the disagreeable concomitant and after-. 
effects. It is said to have been used with satisfaction 
in influenza. 

Salol. — Also called Phenyl saltcylate\ it is repre- 
sented by the formula CeH4 OH.COOCefcfs. It usually 
occurs as a white crystalline and tasteless powder with 
a slight aromatic odor; it is soluble in alcohol, ether, 
turpentine, sandalwood oil, copaiba balsam and the 
fixed oils, but is insoluble in water. The substance has 
been suggested as a succedaneum for salicylic acid; it 
has also antiseptic properties. The drug is said to be 
of value in diseases of the urethra and bladder and in 
inflammatory affections of the pharynx and respiratory 
tract. It has also been used locally in coryza, ozena, 
skin diseases and as a dusting powder. But by far its 
most important application is in infectious disorders of 
the intestinal tract. This is dependent upon the fact 
that under the influence of the alkaline fluids of the in- 
testines the substance is split up into its components, 
carbolic and salicylic acids, Loewenthal and others 
have praised its value in Asiatic cholera, but Reiche 
gays that the expericence of the Hamburg epidemic of 
1892 was suflSicient to demonstrate that the drug was 
useless in this affection whether given internally or by 



187 

injection in ethereal solution. Reynier believes that 
the internal use of the medicament will sterilize the 
urine unless pus be present in large amounts; for this 
purpose its administration must be continued for some 
time. It is probably inferior to boric acid in this re- 
spect however. 

It is usually administered in doses of 5 to 30 grains. It 
is folly to expect this amount to sterilize completely 
the many square feet of mucous membrane of the intes- 
tinal tract, especially when loaded down with infectious 
material. To produce the best results from its use com- 
plete catharsis, followed by irrigation, must precede its 
administration. 

Salophen. — Also termed Acetyl-para-atnidosaloL 
The chemical formula is CeH,.OH.COOCeH,.HCOCH,- 
It is anew synthetic product, the first stage of the manu- 
facture of which is the mixture of equal parts of para- 
nitro-phenol and salicylic acid. Then follow a series of 
more or less complicated changes, which result in the 
ultimate formation of the completed product, which 
occurs in small, thin, lamellar crystals which are odor- 
less, tasteless and have a neutral reaction upon litmus. 
Salophen is freely soluble in alkalies, ether and alcohol, 
but practically insoluble in water 

This substance is proposed as a substitute for salol. 
The gastric juice has no effect upon it, but when it 
comes in contact with the alkaline pancreatic secretion 
it is broken up into salicylic acid and acetyl para amido- 
phenol, which latter is eliminated by the urine and the 
feces. W. H. Flint, of New York thinks the sub^ 



188 

stance of special value in acute rheumatic arthritis; in- 
deed Hitschmann claims that it is almost a specific in 
such condition. These results and conclusions were 
also reached by Hare, E. Koch, Oswald and Harden- 
bergh. E. Koch in experiments upon the value of salo- 
phen says that its antiseptic action is trifling, but that 
its chief field is in nervous affections of various forms, 
such as neuralgia, hemicrania, cephalagia, sciatica, neu- 
ritis, pleurodynia, etc. The remedy when used inter- 
nally is exhibited in doses of from one to one and a 
half drachms daily. 

Sanitas.— This substance, which is used as an exter- 
nal disinfecting fluid, contains of an aqueous solution 
of turpentine, which has become oxidized by the oxy- 
gen of atmospheric air; it contains camphor, thymol, 
hydrogen peroxid and a small amount of camphoric 
acid, the result of such oxidation. It is prepared by 
Kingzett by passing air and steam through oil of tur- 
pentine. It is said to be a good antiseptic and to be 
free from poisonous properties; it is used chiefly as a 
domestic disinfectant. To judge by the formula one 
would hardly give the preparation high germicidal 
power however. Its use seems on the decline at the 
present writing. 

Saprol.— Also termed "Disinfection Oil." This sub- 
stance is a dark and brownish oily mixture, consisting 
chiefly of crude cresols in an excess of those liquid 
hydrocarbons of the marsh gas series which are obtained 
in the refining of petroleum. 

Laser found that the application of one per cent, of 



189 

saprol was sufficient to sterilize urine and feces contain- 
ing typhoid bacilli, or cholera spirilla or other similar 
germs. It is cheap and of some value as a disinfectant, 
but of course has no place in medicine proper except as 
a general disinfectant. It is exceedingly inflammable; 
this property must be remembered or danger may re- 
sult from disregard of its combustibility — the menstrua 
being closely related to benzine, we should naturally 
expect a high degree of combustibility. 

Sennine. — This substance occurs in the form of a 
white powder with a pleasant faintly aromatic odor and 
an agreeable sweetish taste; it is readily soluble in 
water and most of the ordinary solvents. The product 
is a new one and the result of American enterprise, 
and is certainly worthy of commendation. Why 
should we import not only our ideas but even our 
remedial agents, when American brains and Ameri- 
can hands are just as able and competent as those 
of foreign nationalities? Sennine is composed of 
phenol and boric acid, and possesses all of the virtues 
and none of the disadvantages of those substances (see 
carbolic acid and boracic acid). Both of its ingredients 
are substances of more than recognized virtue and 
merit. Lister has very recently declared carbolic acid 
superior to all other antiseptics and germicides, more- 
over, he places boric acid nearly as high in the scale of 
efficiency. In this product, "Sennine," the odor of 
carbolic acid has been entirely removed; a powder re- 
sulting which is not only free from objectionable odor 
and irritating properties, but is also comparatively non- 



190 

toxic; it is readily applied in substance as a dusting 
powder or as a dry dressing — so much in favor at the 
present time — and is dispensed in a most convenient 
metal dusting box for this purpose. It may also be 
applied in ointment, or, where moist dressings are de- 
sired, in solution; a five per cent, aqueous solution being 
sufficiently strong for general use. Its field of applica- 
tion and usefulness is quite extended; it has been re- 
commended not only in general sursjery, obstetrics and 
gynecology, but in general medicine as well. Reports 
indicate that it has been used very effectively in num- 
erous conditions, such as otorrhea, otitis, bromidrosis, 
gangrene, eczemata of various kinds, herpes, laryngitis, 
thrush, diphtheria and various infectious inflammatory 
conditions of the naso-pharynx, vaginitis, chancroid, 
dysentery, erythema, catarrh, typhoid fever, in derma- 
tology and dental surgery; in short, wherever a good, 
efficient and thoroughly reliable antiseptic can be of any 
value whatever. It has been used internally in fermen- 
tative dyspepsia, in cholera and infectious gastro-intes- 
tinal diseases, in gonorrhea, typhoid fever, etc. When 
administered internally, it is usually given in doses of 
one to five grains. 

Sennine is a comparatively new claimant for honors, 
consequently its claims must not only be carefully con- 
sidered,' but they must also be substantiated by clinical 
experience sufficiently extended and feufficiently strong 
to place its virtues beyond a peradventure. Certainly, 
in my experience, Sennine has done more than this. I 
have used it quite frequently as a dry dressing in various 



191 

minor surgical cases and have found it very efficacious 
— superior to Aristol and the various other dry dressings. 
Indeed I once used it in my own case, sprinkling the 
powder freely over the fresh wound; healing was com- 
plete in a very few days without the formation of (i drop 
of pus. The effect was most happy. 

Prof. Bernays, in a recent letter, to the author of these 
papers, upon the subject of antiseptics, calls special at- 
tention to Sennine as a dry dressing as follows: '*Re- 
eently an excellent powder for the dry treatment of 
wounds has been put before the profession in a most 
convenient form under the name of ^'-SennineP In a 
very recent contribution he reports a most interesting 
and successful operation for the removal of an excess- 
ively large cervical fibro-myxo-chondro osteo-sacroma of 
branchial origin; in this operation the only antiseptic 
used was Sennine — the result was most excellent, leav- 
ing, indeed, nothing to be desired, if results mean any- 
thing. To quote his own words: ''There was union by 
first intention; no elevation of temperature and no sup- 
puration. The dry dressing was used and the incision 
or line of suture thickly dusted with an antiseptic 
powder consisting of boric acid and phenol. This pre- 
paration has recently been introduced by the Dios 
Chemical Company, and is put up in a tin box with per- 
forated lid. It is called 'Sennine,' and is made by a 
chemist whose qualifications I know, and I am glad to 
recommend the preparation, because it is a scientific 
one, and is put up in such a neat and practical manner, 



192 

as to readily answer the requirements of the busy sur- 
geon in private, as well as hospital practice." 

He says further of it that: **It affords me pleasure 
to state that I have used ^Sennine' in my practice with re- 
sults entirely satisfactory to myself. I say without any 
hesitation as a dry dressing it is unexcelled. I consider 
it preferable to aristol, europhen and iodoform, as it is 
free from toxic and irritating effects as well as unpleas- 
ant odor. Five per cent is perfectly soluble in 100 parts 
of water, making a reliable antiseptic wash as well." 

A. H. Ohmann-Dumesnil, late Professor of Dermatol, 
ogy and Syphilology to the St. Louis College of Physi- 
cians and Surgeons, and President of the Sections of 
Dermatology and Syphilography of the American 
Medical Association and the first Pan American Medi- 
cal Congress, has used the substance in various derma- 
toses and as a dressing after such operations as the ex- 
tirpation of wens or sebaceous cysts. In giving a 
detailed report of three cases of removal of sebaceous 
cysts, he says: 

"In all of these cases the powder was employed in 
preference to any solution and care was taken not to 
apply the powder until the flow of blood had ceased. 
* * * The powder acts as an effectual barrier to the 
entrance of any micro-organisms and secures a dry, 
clear wound, a condition not so readily obtained from the 
employment of liquid antiseptics P He has also used the 
same substaoce to advantage in herpes progeni talis and 
gives his method in full thus: 

"The method consists in^treating an attack as soon as 



193 

it occurs. Each vesicle is opened with a needle knife^ 
thus emptying it of its contents. The wall of the vesi- 
cle should not be merely punctured but cut so as not to 
give it an opportunity to refill. In this manner the pos- 
sibility of suppuration is avoided. After the vesicles 
have been opened the following powder should be ap- 
plied: 

1^ Sennine, 

Zinci stearat. co., - - . aa 5^]' 

M. 

Sig. Apply twice a day. 

This should be applied twice daily, the proportion of 
Sennine being gradually increased until it is used pure. 

Should the vesicles have ruptured and suppuration 
set in, the pure Sennine powder should be applied twice 
daily. In all cases before applying the powder, be 
there suppuration or not, the parts should be cleansed 
by letting warm water drip on them, The rapidity of 
the healing is marked, as well as the disappearance of 
the subjective symptoms." 

He also says further: 

"Sometime ago my attention was called to Sennine 
as a good dry surgical dressing. I have had occasion 
to use it in my dermatological practice and I find it is a 
most excellent application in various troubles. It is of 
value after the removal of sebaceous cyst, insuring a 
rapid union by first intention. It is also a good prepa- 
ration in the moist or 'weeping' forms of eczema, not 
only protecting the inflamed tissue and relieving them 
from the moisture, but acting as an antipyretic as well. 



194 

In furuncle it also acts well after the lesion has been 
opened and emptied of its contents. It is also excellent 
(when used as a dusting powder) in many cases of 
herpes simplex and herpes progenitalis. In fact, as a 
dry surgical dressing, it is possessed of valuable proper- 
ties and is in itself a cleanly preparation, devoid of 
odor. 

"It is composed essentially of boracic acid and phenol. 
It is a good antiseptic and is not irritating. On the 
contrary it possesses anti-pruritic properties and has 
the advantage of being susceptible to use in powder, 
ointment or liquid form. It is feoothing to the end 
terminations of irritated nerves and is destined to ac- 
quire a place in dermatological therapeutics." 

Yarnall has had an extensive experience with Sennine 
and in a recent report to the St. Louis Medical Review 
says of it: 

"Since the introduction of 'Sennine' to the profession 
I have been using it in all appropriate cases and with 
such satisfactory results that I cannot refrain from 
recommending it. 

"In vaginitis and leucorrhea it is admirable and it 
has proved especially efficacious in pruritus. An espe- 
cially obstinate case of the latter with a pregnant 
woman yielded after resorting to every method that had 
suggested itself to the writer. Improvement set in at 
once in this case with the use of Sennine. Local ap- 
plications were made not only within the vagina on pre- 
pared wool, but were also freely applied externally. At 
this writing the pruritus and irritation is entirely con- 



195 

trolled, For ulcerations specific and non-specific it is 
equally applicable. 

"In chancroidal sores it is in my opinion equal to any 
treatment that can be resorted to,— in short it is valua- 
ble in any and all the various antiseptic uses for which 
it is designed and recommended. 

*'It is remarkable how largely preparations of this 
character enter into the practice of every medical man 
and how many there are offered. The eligible form in 
which 'Sennine' is presented — its non-toxic and unirri- 
tating properties — except in cases of extreme sensitive- 
ness, when it should be mitigated with powdered starch 
or fuller's earth, and its real therapeutic value must 
place it at the head of the long list of similar articles." 

Dr. C. H. Mastin, of Mobile, who is one of the best 
known surgeons of the South, has used Sennina and 
says that "it is a good combination for dry dressing. 
It is put up in a convenient form and I shall continue 
to use it." Dr. Mastin's opinion always carries great 
weight, he being a serious and thorough investigator. 

Dr. Morse, the author of "New Therapeutic Agents," 
says: "I consider Sennine as an ideal antiseptic. It 
has no faults, chemical or therapeutical. In composi- 
tion 'a chemically pure product of boracic acid and 
phenol,' it has the full properties of both drags. It is 
not poisonous. It cannot irritate. It effectually de- 
stroys all germs. It has a lasting effect. It grows in 
favor." 

Professor Senn has used the substance most success - 
fully as an antiseptic dry dressing in twenty-four caseg 
in his Chicago clmigs. 



196 

Dr. Heine Marks, Surgeon in-Chief of the St. Louis 
City Hospital is preparing a report of forty-eight cases 
of gun-shot wounds in which the use of Sennine as a 
dry dressing gave most satisfactory results. 

Very recently Dr. Broome read a paper before the 
Medical Society of St. Louis, reporting an exceptional 
operation in which Sennine as a dry dressing gave ex- 
cellent results. 

Oatman has used it successfully in rectal ulcerations 
with stenosis. Roger Williams considers it superior to 
Aristol, Europhen and other similar preparations. Nold, 
Scrivner, Harder, Brodnax, Hardesty and indeed many 
others who have used the product have been uniform in 
their praise; their experience has been fully confirmed 
by the results given in the author's own practice, he, at 
present, using Sennine almost exclusively as a dusting 
powder and dry dressing. 

In view of the fact that antiseptics are numerous and 
thoroughly reliable ones so scarce (in spite of the opti- 
mistic claims of each particular manufacturer) the 
writer has seen fit to occupy much space in attempting 
to put forward, though hardly in an adequate manner, 
this new claimant for antiseptic honors because it seems 
to him a preparation in which the physician and sur- 
geon will find much of use and value. The present is 
peculiarly an era of dry dressings and Sennine is cer- 
tainly gaining in popularity and favor each day — what 
more the future will do with it remains to be seen. As 
for the present, certainly ita virtues and record suf" 
ficiently attest its value. 



197 

In a letter recently written to the author upon the sub- 
ject of antisepsis by Prof. G. W. Broome, of St. Louis, 
he most aptly says: 

"Any physician may see and appreciate the great 
value of dry dressings in surgical cases. I may go a 
little further and venture the prediction that the scien- 
tific surgery of the near future will not even include the 
now widely used irrigating vessels in the instrumenta- 
rium of the surgeon at all. Instead of irrigations the 
asepticity of a wound will be secured and maintained 
by dry sponging. In suppurating cases acepsis will be 
established by destroying the medium in which the 
pyogenic micro-organisms grow and multiply by the 
same means. The availability of any antiseptic is en- 
hanced in proportion to the degree of its inhibitory 
power. The inhibitory function can be performed per- 
fectly in a dessicated field only. Dessication can only 
be secured by means of dry, together with hygroscopic 
dressings. A suppurative inflammation with the pres- 
ence of pus wherever found in the human body, must 
be treated by dry sponging, not by irrigation; so that it 
will only be a little while until the application of pow- 
ders possessing such power will be a universal practice 
among progressive surgeons. 

'^Latterly, I have been using ^Sennine' to dust over 
laparotomy wounds and have found it superior in many 
essential particulars to other antiseptic powders, ^^ 

Silver Nitrate.— AgNO.,. Also called Argentic nit- 
rate and ^^Lunar Causfic^^— the latter term being a relic 
of the days of alchemy, when the element mlver wa§ 



198 

known by the name and zodiacal sign of Luna. It is a 
crystalline substance, soluble in water and possessing 
the property, in the presence of moisture and heat, of 
staining organic matter black— this property is made 
use of in the so-called indelible inks. 

This silver salt has marked antiseptic properties. 
Miquel and Behring, while laboring under the impres 
sion that corrosive sublimate was the best germicide, 
placed it next in efficiency to corrosive sublimate — in- 
deed, even superior to that much-vaunted agent in the 
presence of albumin. 

The experiments of Behring seemed to demon- 
strate that in a solution of the strength of 1:10,000, 
anthrax spores were destroyed in forty-eight hours. 
The chief objections are the disagreeable property of 
indelibly staining organic matter and the fact that its 
germicidal efficiency is much impaired by the presence 
of chlorids-— that of sodium (NaCl) for instance, which 
is present in appreciable quantities in such fluids as the 
urine. This is owing, as has been previously explained, 
to the formation of comparatively inert and insoluble 
silver chlorid. 

Skatol. — Koch has proven that this substance, even 
in excess*, in water has no germicidal power as far as its 
action upon anthrax spores is concerned. 

Smoke.-— This substance possesses inhibitory proper- 
ties which have been known for ages; these properties 
have been made use of in the preservation of meats. 
The preservative properties of smoke are due to the 
pyroligueous acid and creosote which are contained 



109 

thereioj although in small quantities. Beu and Petri 
have shown that salted and smoked meats have contain- 
ed bacteria undestroyed for six months; after that time, 
however, they usually failed to give any evidence of 
vitality. Hence we may conclude that smoke only ex- 
ercises germicidal power upon long exposure either to 
its action or to that of its active principles. 

SoDio Carbonate.— ISajCOa. This substance is more 
commonly termed Soda or Washing Soda. It is too 
familiar a compound to need extended description. 
Kitasato found that typhoid bacilli were killed in from 
four to five hours by a 2,4? per cent solution and that 
the spirilla of cholera were also destroyed by a 3.45 per 
cent solution. 

SoDic Chlorid. — NaCl. This substance is better 
known as Salt — common salt. It is supposed by the 
laity, and indeed by many physicians, to possess valua- 
ble antiseptic properties. This is far from the truth, 
however; saturated solutions failed to destroy any bac- 
teria (except the spirillum of cholera, which was killed 
in a few hours) even after prolonged exposure to its 
action. Experiment has demonstrated the fact that 
saturated solutions are utterly powerless to destroy or 
sterilize cultures of the tubercle bacillus even in two 
months exposure. Miquel has determined that the sub- 
stance is antiseptic in the proportion l:d. 

SoBio Hydroxid.— -NaOH. Better known as Caustic 
Soda. This substance has about the same germicidal 
activity as the analogous potassium salt (See potassic 
hydroxid). Miquel has determined that it is antiseptic 
in the proportion 1:56. 



20@ 

SoDic Di-iODO-SALicYLATK. — This substance usually 
occurs in white acicular crystals. It possesses antisep- 
tic properties and has been used chiefly as a dusting 
powder in the treatment of parasitic diseases of the skin. 
Its use seems to be somewhat limited thus far. 

SoDic Di-THTo-SALiCYLATB. — This substance occurs as 
a grayish- white powder which is very hygroscopic and 
is also soluble in water in the proportion 1:1— that is, 
equal parts. This sulphur derivative of the sodium salt 
of salicylic acid has antiseptic properties; it has been 
used locally, as in ozena, and has also been used inter- 
nally in the treatment of gonorrheal rheumatism and 
rheumatic fever. When so administered the usual dose 
is 3 grains given about twice per diem, 

SoDic Paracrbsotate. — NaCgH^Os. This salt of 
paracresotio acid occurs usually as a fine, white crystal- 
line powder with a bitter taste; it is somewhat soluble 
in warm water (about 1:24). It is said to possess anti- 
septic as well as antipyretic properties and is said to 
have given successful results when used. The usual 
dose is 1-20 grains, but as an antiseptic it is given in 
doses of 1-8 to 1-4 of a grain. 

SoDic SozoiODOLATE. — NaCeHjIgOHSOs. This com- 
pound occurs in the form of well-defined but colorless 
prisms. The substance is spoken of as an antiseptic; its 
chief uses so far have been in the treatment of syphilitic 
ulcers (as a substitute for iodoform), in diseases of the 
bladder and also in catarrhal affections of the nasal 
mucous membrane. The salt may be used locally as a 
dusting powder or in solutions of the strength of one 



201 

per cent or else in the form of an ointment of about ten 
per cent strength. 

SoBic SuLPHiTE.~Na,SO.v Sternberg obtained en- 
tirely negative results from the use of this sodium salt 
of sulphurous acid. For a long time the sulphites and 
the hyposulphites enjoyed popularity as germicides of 
reputed value; but recent researches indicate that they 
are utterly devoid of germicidal power and hence the 
sanguine expectations of Polli of Milan have not been 
realized in this direction. They do not seem to have 
any material effect upon the process of fermentation and 
as fermentation without the presence of bacteria is an 
impossibility, the inference is obvious. 

SoDic SuLPHocARBOLATE.— NaCeH5S04.2H20. This 
is the sodium salt of sulphocarbolic acid, and is ob- 
tained as a white soluble salt by dissolving sodic car- 
bonate in sulphocarbolic acid. It is closely allied in 
chemical nature as well as antiseptic activity to the zinc 
salt of the same acid. (See sulphocarbolic acid, also 
zinc sulphocarbolate.) 

SoDic Tetraborate.— This term is only properly ap- 
plied to common borax, which is the sodium salt of 
tetraboric acid. However a different substance is 
erroneously described under this name by Squibb, Cerna 
and other writers. This spurious tetraborate is de- 
scribed as a compound resulting from the mixture and 
application of heat to equal parts of borax, boric acid 
and water; upon cooling a neutral compound is said to 
result. It is a well known fact that boric acid yields 
metaboric acid upon the application of heat to boiling. 



202 

It is exceedingly probable then that the action of heat 
upon the mixture results in the formation of sodic 
metaborate, which crystallizes out from the resulting 
liquid, water being simply a vehicle. The reaction 
could be expressed thus: 

Borax. Boric Acid. Sodic Metaborate. Metaboric Acid. 

NajB^Ot+HsBO.-^ heat = 2NaB02 + 3HB0,. 

This so called "tetraborate," which is probaly a meta- 
borate, occurs in hard, transparent and clustered crys- 
tals with a neutral reaction npon litmus. It is some- 
what soluble in water and is said to possess antiseptic 
properties which are similar to if not greater than those 
of borax and boric acid. Water at the ordinary tem- 
perature dissolves about sixteen per cent, of the sub- 
stance, and it is this saturated aqueous solution which 
is used locally in medicine. Menz finds that it has the 
disadvantage, however, of forming hard crusts on surgi- 
cal dressings; these hard crusts are objectionable be- 
cause irritating to abraded surfaces. This is undoubt- 
edly due to crystallization by evaporation of the aqueous 
menstrum of the solution used. Thus far the substance 
hss received little recognition. 

Sodic Thiophensulphon ate.— -This substance is a 
thiophen derivative of the sodium salt of. sulphonic 
acid, and is represented by the chemical formula C4H3 
S.NaSOs. It usually occurs as a white, crystalline 
powder which has been used chiefly as a dusting 
powder in various diseases of the skin; it is said to be 
superior, for such use, to beta-naphthol. 

Sodic Thio-sulphatb.— NaaSaOg. This is the sub- 



203 

stance commonly and erroneously termed the hyposul- 
phite. Hypo-sulphurous acid is HaSOjj and its sodium 
salt would be NajSOs — the only correct chemical formula 
for sodic hyposulphite. The substance commonly called 
the hyposulphite or "hypo" is really the sodium salt of 
thiO'Sulphuric acid HjSjOs. 

The so-called hyposulphite has been vested with anti- 
septic powers in the minds of physicians ever since the 
day of the extravagant claims of PoUi of Milan— indeed 
even earlier. The experiments of Arloing, Cornevin 
and Thomas prove it, however, to be utterly devoid of 
germicidal power. Miquel has determined that it is 
antiseptic in the pproortion 1:3— this indicates feeble 
powers. (See sodic sulphite.) 

SoLUTOL.— This substance belongs to the same class 
of bodies as creolin, cresin, lysol, saprol, solveol, etc. 
It is a combination of cresol (cresylic acid) and sodic 
cresylate; it contains about sixty per cent, of cresylic 
acid, one-fourth of which is free and the remaining 
three-fourths being combined with sodium to form the 
cresylate. Cresol itself is insoluble, and sodic cresylate 
is therefore used to render it soluble, otherwise it would 
be practically useless. We may therefore consider 
solutol to be an alkaline solution of sodic cresylate in 
excess of so called cresylic acid (cresol.) In this re- 
spect it is markedly similar to, indeed almost identical 
with cresin, which see. 

It makes a very effective preservative for cadavers, 
and hence may be service in the dissecting room. It is 
also of great use for the disinfection of closets, sinks, 



204 

infected bed clothing, infectious sputa or other such 
discharges, etc. Its caustic and strong alkaline nature, 
precludes its use in surgery, either as an application or 
even in surgical dressings. It has played no part in the 
medical literature of the past year. 

SoLVEOL. — This substance is analogous to solutol, 
being a solution of cresylic acid (cresol) in sodic creso- 
tate. It usually occurs as a dark liquid with a little 
odor and a neutral reaction; it is soluble in water 
While slightly caustic and irritant it is not as markedly 
so as solutol. It is also not so greasy as either creolin 
or lysol. It is usually used in strengths of one-half to 
one per cent., being slightly irritant in such proportion. 
Hueppe seems to think that it is superior to carbolic 
acid, but this opinion does not seem to be upheld by the 
surgical world, at least it has been unable to supplant 
carbolic acid in surgery. 

SozAL.— This substance is the aluminum salt of para- 
phenyl-sulphonic acid (also termed sozonic acid). It is 
somewhat allied to Alumnol, the aluminum salt of naph- 
thol-sulphonic acid. It occurs in the form of crystals, 
which have an astringent taste and a slight odor of car- 
bolic acid; it is soluble in water and does not seem to 
decompose very readily. It has been recommended for 
use in surgical dressings, although it is but a feeble anti- 
septic. If one may judge from its disappearance from 
medical literature, it seems to have practically j)assed 
from use. - 

SozoioDOL.— This substance is also termed Di-iodo- 



205 

para-phenyl-sulphonic acid. Squibb gives the following 
method for its preparation: 

"About two parts of crude carbolic acid are added 
very slowly to one part of strong sulphuric acid. The 
reaction raises the tpmperature to about llO^C. and 
continues for two or three days, when para^phenyl-sul- 
phonic acid (sozonic acidj is formed. Any excess of 
carbolic acid is removed and then iodine is added to 
form this sozo-iodolic acid (sozo-iodol)." 

It occurs in acicular prisms which are free from odor 
and readily soluble in alcohol, water and glycerine. It 
has been employed as a local antiseptic in diseases of 
the skin and naso-pharynx; also in venereal diseases 
and wherever iodoform is applicable. It is used locally 
as a dusting powder, or in gauze, or in collodion, or in 
solution in strengths of 5 to 20 per cent. The aluminum, 
ammonium, lead, potassium, sodium, zinc and mercury 
salts of this acid are employed more frequently than the 
acid itself. The sodium salt seems to be the most 
favored derivative thus far; it occurs in bright, some- 
what prismatic acicular crystals, which are odorless and 
employed either in substance or else in 5 to 10 per cent, 
aqueous solutions. Guttmann reports thirty cases of 
pertussis in which nasal insufflation of the substance 
gave good results. 

Witthauer has employed the mercurial salt in powder, 
emulsion and ointment with what appears to be good 
effect. 

Draer claims that preparations of this substance, and 
of the free acid and mercurial salt in particular, possess 



206 

marked disinfectant action when brought into contact 
with cholera spirilla, and also that sufficient strength of 
solution and length of exposure is able to completely 
prevent their growth. This, however, Hueppe directly 
contradicts. Suffice it to say that the substance is not 
growing in favor. 

Steresol. — This is the name for an antiseptic var- 
nish introduced inio therepeutics by Berlioz. It is re- 
commended for use in diphtheria and in certain skin 
affections. Two formulas for the substance are given, 
the first of which is from Blanc. 

Grms. 

(ium. Lac, » 5a 

Gum Benzoin, » - - . * 5. 

Balsam Tolu, - - '= - - 5. 

Cry St. Phenol., 1.5 

Alcohol sufficient to dissolve. 

IL 

Grms, 
Purified Gum Lac, - - - - 270 
Purified Gum Benssoin, - - - » 10 
Balsam Tolu, ^ ■= => - - 10 

Cryst. Pheno - - - - » 180 
Oil of Cassia, ... - - 6 

Saccharin, - 6 

Alcohol sufficient to make 1 litre. 
No clinical reports have been received in regard to 
this preparation as yet; it is therefore impossible to de- 
cide its status. 



207 

Styeacol.— This substance is the cinnamic ether of 
guaiacol, and is produced by heating cinnamyl chlorid 
and guaicol together. It has the chemical formula 
C5H5.C«H4.0CH3.CH:CH.CO.O. It occurs as a crystal- 
line needle-like powder. It was suggested as a local 
antiseptic, also internally in pulmonary tuberculosis, in 
diseases of the gastro intestinal tract, in chronic vesi- 
cal catarrh, and in gonorrhea. Expeiience has hardly 
justified these expectations, however, and like many 
others of its therapeutic brethren it seems to have died 
the death. 

Styron — This substance is a compound of Peruvian 
balsam and liquid storax. It has been used locally in 
ulcerations, and has been suggested for administration 
in cholera. It has been employed in the spray in a 
strength of four per cent.; in solution in the strength 
of eight per cent., and for introduction into serous 
cavities, such as those of the chest and abdomen, in 
solutions of varying strengths from 1:200 down to 1:50. 

It is but little heard of recently. 

SuLPHAMiNOL. — Alto termed Thio-oxy'di phenyl-amiu^ 
It is obtained by the action of sulphur upon the salts of 
metaoxy-di-phenyl-amin. It occurs as a light, pale- 
yellow, odorless and tasteless powder, which is insolu- 
ble in water but freely soluble in the alkalies, acetic 
acid and alcohol. Its solutions retain the pale-yellow 
color. It seems to possess the power of checking the 
formation of pus to some degree, and this is considered 
by some its chief claim to recognition in therapeutics; 
although its antiseptic power, if it has any at all, is 



208 

very weak. It has been used in powder in wounds, and 
has been insufflated into the nasal fossae and sinuses of 
that region with some apparent benefit. It has been 
recommended in gastrointestinal disorders on the sup- 
position that the digestive fluids decompose it into car- 
bolic acid and sulphur. However, it is used chiefly as 
a local application^ as are also its derivatives sulph- 
aminol-creosote, sulphaminol-eucalyptol, sulphaminol 
guaiacol and sulphaminol-menthol. When admin- 
istered internally it is usually given in single doses of 
four grains, or daily doses of fifteen grains. 

Wojtaszek conducted a series of experiments upon 
rabbits in order to test the claims of the advocates of 
sulphaminol. After such experimentation he concludes 
that "sulphaminol is devoid of any physiological action. 
As regards its alleged antiseptic properties, they also 
seem to be about «//." 

Squibb says that the substance has not been in gen- 
eral use during the past year, and that even during the 
year before last few reports concerning it appeared in 
medical literature. 

SuLPHOCARBOLic AciD. — HCeHgSO^. Also termed 
Phenol-sulphonic acid^ Sozolic acid and AseptoL It is 
formed by the action of concentrated sulphuric acid 
upon phenol (carbolic acid). Icthyol is sodium or 
ammonium icthyo-sulphonate, a derivative of this acid; 
it is a natural product, however. The acid itself is not 
so much used in medicine, its derivatives being in com- 
moner use; the chief of these are the sodium and zinc 
salts (which see). 



209 

SuLPHUME.— This substance has been also called, 
"Pure Liquid Sulphur" (!) It is nothing more nor less 
than an aqueous solution of the higher sulphids or sulph- 
hydrids of sodium and potassium saturated with sulphur, 
with traces of the sulphids of calcium and magnesium. 
It> is very ingenuously but not ingeniously recommended 
by the manufacturer for skin diseases, open sores and 
ulcers, ulcerated throats, diphtheria "and other affec- 
tions." It is almost totally devoid of germicidal power, 
however. 

Sulphur Di oxid. — SOj. This substance is errone- 
ously termed ^^ Sulphurous acicC^ and ^^ Sulphurous acid 
gasP It is produced by the burning of sulphur— that 
is, by its oxidation, thus: 

8 + 0, = SO,. 

It is very extensively used for purposes of fumiga- 
tion, but has little or no use in medicine or surgery 
proper. 

Sternberg (1880) found that this substance, which is 
a gas, disinfected dried vaccine virus exposed for twelve 
hours on ivory points to the action of an atmosphere 
containing one volume of the gas. The liquid virus, 
however, exposed in a watch-glass, was disinfected by 
one-third of this amount. 

Sternberg (1885) found that pus micrococci were 
killed by an exposure for eighteen hours to the action 
of a dry atmosphere containing twenty volumes of the 
gas (SO2) — four volumes per cent failed. Experimental 
data force us to the inevitable conclusion that this sub- 
stance, like chlorin, is much more active as a germicide 



210 

in the presence of moisture. Moisture, as is the ease 
with chlorin also, causes a bleaching action as well as 
an antiseptic one. An aqueous solution of the gas will 
give true sulphurous acid (H2SO3) thus: 
SO, + H/) = H2SO3. 

The presence of moisture is essential to this 8ubstant3e 
(SO2) if germicidal power is to be exercised by it. In- 
deed, in the pure state anhydrous sulphur di-oxid does not 
destroy spores^ even when the gas is liquefied by pressure. 
Moisture is essential. 

Thinot (1890) has come to the conclusion that the 
specific germs of tuberculosis, glanders, farcy of cattle, 
typhoid fever, cholera and diphtheria are destroyed by 
an exposure of twenty-four hours to an atmosphere con- 
taining the gas developed by the combustion of sixty 
grains of sulphur for every cubic metre. 

The American Public Health Association in directing 
the use of this substance as a disinfectant recommends 
that the infected articles be "exposed for twelve hours 
to an atmosphere containing at least four volumes per 
cent of this gas in the presence of moisture!'^ 

Sulphuric Acid.— This substance is too familiar to 
need description— suffice it to say, in this regard, that its 
chemical formula is H2SO4. 

Koch (1881) found that anthrax spores grew after ex- 
posure to a one per cent solution for twenty days. 

Sternberg (1885) demonstrated that a four per cent 
solution failed to destroy the vitality of the spores of 
the Bacillus subtilis in four hours. 

Seitz found that the dejecta of typhoid patients, when 



§11 

mixed with equal parts of the disinfecting solution » 
were sterilized by a fire per cent solution in three days. 
The evidence in the case forces us to the conclusion that 
sulphuric acid possesses considerably less germicidal 
power than carbolic acid. 

Sulphurous Acid. — ^HgSOs. Sternberg (1885) found 
that micrococci were destroyed in two hours by 1:2000 
by weight of sulphurous anhydrid (SO^) added to water. 
He also demonstrated that pus cocci fail to grow in an 
aqueous solution of the strength 1:5000. 

De la Croix determined that one gramme of sulphur 
di-oxid when added to two thousand parts of bouillon 
prevented the development of putrefactive bacteria and 
finally destroyed their vitality after a time. 

Kitasato found that typhoid bacilli were killed .28 per 
cent and cholera spirilla by .148 per cent in five (?) 
hours. 

Tannic Acid. — Ci^HioOg. This substance, also called 
Tannin^ is too familar to physicians to need description. 
It is more commonly used as a tonic, hemostatic and 
styptic but experiments demonstrate that it possesses 
more or less antiseptic activity, A twenty per cent so- 
lution failed, after two hours exposure, to destroy the 
spores of Bacillus anthracis and Bacillus subtilis, Ab- 
bott however demonstrated that a solution of the 
strength 1:400 (.25 per cent) destroyed micrococci. 
Kitasato found that 1.66 per cent destroyed the typhoid 
bacillus in live hours and 1.5 per cent effected the same 
result in the same time in the case of cholera spirilla. 



212 

Miquel has determined that it is antiseptic in the pro- 
portion of 1:201. 

Tartaric Acid.— H^C.H.Oe or CaH,. (OH),. (COOH)^. 
This substance, which is manufactured from grape- 
wine deposits (argol), is used in medicine and the arts. 
It is sufficiently common to need no description. The 
substance seems to be about equal to tannic acid in an- 
tiseptic activity. 

Abbott found that micrococci were killed in two 
hours by a solution of the strength 1:400. As was also 
the case where tannic acid was used, a twenty per cent 
solution failed to destroy the spores of Bacillus anthra- 
cis and Bacillus subtilis: Hansen has shown however 
that its germicidal power is limited to a comparatively 
small number of species— indeed whole species of micro- 
organisms are not only unaffected by tartaric acid but 
even actually favored by it. 

Terebene.— CijHie. This substance is supposed to 
be a modification of terpene, produced by the distilla- 
tion of oil of turpentine with sulphuric acid; it is sup- 
posed to contain camphene, cymene, terpilene and bor- 
neol. It is a light yellow liquid with the odor of fresh- 
ly-cut pine wood, or the odor of thyme. It is somewhat 
soluble in ether and alcohol but practically insoluble in 
water. It is said to be an agreeable antiseptic, a five 
per cent solution is said to have made a very serviceable 
surgical dressing. It has been used by inhalation in 
bronchial affections and in pulmonary tuberculosis. 

It may be used internally in capsules or in emulsion 



213 

in doses of 4 to 6 minims; or externally in five per ceilt 
solutions. 

Teepine. — CioHi8(OH)3. Aq. The hydrate of terpine 
is obtained by the action of alcohol, nitric acid and oil 
of turpentine upon each other. It occurs in white, odor- 
less, rhombic crystals with a faintly aromatic taste. It 
is soluble in alcohol and boiling water but only moder- 
ately so in cold water, benzene, turpentine and carbon 
disulphid. It has antiseptic and expectorant properties, 
it is said. It has been recommended for use in bronchi- 
tis and whooping-cough. It is given in doses of 2 to 6 
grains, preferably in tablets or in alcoholic or syrupy 
mixtures. 

Thalline. — C9HioN(OCH3). This substance is also 
termed Tetra-hydro-para-methyl-oxy-chinolin^xi^ Tetra^ 
hydro-para-chinonisoL It is formed by heating acrolein 
and para-amido-anisol together with some oxidizing 
agent. At ordinary temperatures it is a liquid which 
forms, when cooled, a yellowish-white, crystalline pow- 
der with a bitter, saline taste and a peculiar somewhat 
aromatic odor. It is soluble in water; its two chief 
salts, the sulphate and the tartrate, which are used in 
medicine, are soluble in water and slightly so in 
alcohol. Wood speaks very briefly but also very un- 
favorably of the substance. It has been used in gonor- 
rhea, in one and a half per cent injections and two per 
cent bougies, with apparent success. 

Thilanine. — This substance is a sulphuretted lanolin 
produced by the action of sulphur upon lanoline and 
containing about three per cent of sulphur. It is a yel 



214 

lowish-brown substance regembling vaseline and devoid 
of irritating properties. It has been used locally in 
dermatology, being designed to replace ichthyol and 
thiol. 

Fox, after experience with the medicament, concludes 
that it possesses no single advantage over the remedies 
commonly used. It is objectionable, however, on ac- 
count of its color, odor and high price. It seems to 
have received little or no attention during the past year 
and has probably passed out of use. 

Thiol. — Thiol is a mixture of sulphuretted hydrocar- 
bons, it is an artificial substance designed as a succeda- 
neum for ichthyol; this latter substance is obtained by 
the distillation of a bituminous oil, it contains ammon- 
ium and probably also sodium ichthyo-sulphonatCj—it 
is used chiefly in dermatology, having no active germi- 
cidal properties though said to have the power of arrest- 
ing the growth of bacteria. Thiol occurs in two forms; 
one, a liquid, which exists as a thin, brownish extract 
slightly heavier than water and is not the purified pro- 
duct, it is therefore cheaper and oftener used; the other 
occurs as a fine brown powder, or else in scales. It is 
soluble in water, especially in the presence of glycerin. 
The substance is chiefly used by dermatologists and 
gynecologists. Reports as to the results of its use in- 
dicate that it is free from odor and irritating properties, 
does not cause bleeding from raw and eroded surfaces, 
promotes absorption of effusions — and indeed has such 
advantages over ichthyol itself that it bids fair to dis- 
place the latter substance. Thiol may be given intern- 



215 

ally in doses of one and a half grains; locally it may be 
applied as a dusting powder, or else in ointment or else 
in solutions of 10 to 50 per cent strength. 

Thiophen.— C4H4S. This substance is a sulphur de- 
rivative of benzene. Indeed Meyer has pointed out the 
fact that it occurs in all of the commercial benzenes de- 
rived from coal-tar. It may be isolated by agitation 
with one-tenth volume of concentrated sulphuric acid. 
The substance occurs as a clear, colorless and volatile 
oil which is insoluble in water. 

Thiophen itself has been but little used in medicine, 
but its derivatives, lead and sodium thiophen-sulphonate 
(which see) and thiophen di-iodid, have been favorably 
reported on from Kaposi's clinic in Vienna. 

Thiophen di-iodid (CiHJjS) occurs in beautiful, small, 
crystalline tablets which are volatile at ordinary temper- 
atures and which are also insoluble in water; the com- 
pound has been used as a substitute for iodoform, being 
employed in all conditions in which iodoform would be 
considered indicated. Hock, of Vienna, says that its 
use in the powder in surgical dressings seems to retard 
the formation of pus and to prevent the occurrence of 
of exuberant granulation. It is used in the form of a 
dusting powder, or else in gauze. Its freedom from ob- 
jectionable odor and its non-toxic and non-irritating 
properties have been demonstrated by clinical experi- 
ence. 

Thiobesorcin. — CeH4(OS)2. This substance results 
from the combination of resoroin, sodic hydroxid, sul- 
phur and hydrochloric acid. The product occurs in the 



216 

form of a floceulentj grayish white^ non-irritating, taste- 
less and odorless powder which is insoluble in water 
but slightly soluble in alcohol and ether. It has been 
suggested and employed as a substitute for iodoform 
and has been used as a dusting powder, especially in 
the treatment of ulcers of the leg. 

Thymol.— C10H13OH. This substance is obtained 
from the volatile oils of thyme and other plants. 
It occurs in large, transparent plates or in acicular crys- 
tals which are insoluble in water but soluble in the 
fatty and essential oils. It has been used by inhalation 
in pertussis and various pulmonary affections; it has 
also been employed internally in various gastrointesti- 
nal diseases and in rheumatism. It is said to have given 
good results in the treatment of wounds, skin diseases 
and various affections of the mouth. 

This product was introduced into medicine by Ranke 
of Halle, in 1878, and was much lauded on account of 
its comparative freedom from poisonous and irritating 
properties, but clinical experience has][in nowise war- 
ranted the brilliant expectations, they have not been 
fulfilled. A five per cent solution does not destroy 
anthrax spores, even in fifteen days' exposure to its 
action, as has been demonctrated by Koch; but their 
development is somewhat restrained by 1:80,000 he 
states. Yersin found that the substance itself required 
three hours to destroy the tubercle bacillus. Behring after 
careful investigation, pronounces that it possesses four 
times less germicidal power than carbolic acid, and yet 
Ranke fondly believed it to be a formidable rival of the 



217 

latter. Miquel has determined that it is antiseptic in 
the proportion of 1:1340. 

Tin Chlorid. — This substance, in one per cent solu- 
tion and acting for two hours, destroyed the bacteria of 
of putrefying bouillon, but an .8 per cent solution failed 
to accomplish this. 

Tobacco Smoke, — Tassinari demonstrated that to- 
bacco smoke possesses the power of restraining the de= 
velopment of bacteria— especially certain species, as 
Friedlaender's bacillus and the spirilla of cholera, which 
fail to develop after exposure for half an hour to an 
atmosphere of tobacco smoke. 

TuMENOL.— This is a comparatively new compound 
which is produced by the treatment of the unsaturated 
hydrocarbons of mineral oils with sulphuric acid, and 
is closely allied to ichthyol. It occurs as a dark-brown 
fluid which Neisser, of Breslau, seems to consider an 
efficacious compound. He says that the substance and 
its compounds, whose action seems to be chiefly super- 
ficial, owe their virtues to their strong reducing proper- 
ties rather than to the sulphur in their composition, 
which latter is true in the case of ichthyol. It has been 
recommended in pruritus, moist eczemata, etc. It has, 
however, no antiparasitic or germicidal powers and 
hence is of no service in erysipelas. But little has been 
heard of the substance in this country as yet. 

Valerianic Acid. — HCjH^Oj or better C^H^.COOH. 
This acid is an oily, colorless, liquid with a penetrating 
and characteristic odor; it is but slightly soluble in 
water but is soluble in alcohol. It is found in valerian 



and angelica root but is generally prepared by the oxi- 
dation of amyl alcohol. Koch found that a live per 
cent solution failed to destroy anthrax spores even after 
five days' exposure. 

Xylol.— CgHi^. Also termed Xylene and Di-methyl- 
benzene. This substance, as its chemical formula indi- 
cates, is a hydrocarbon and resembles benzene. It is 
said to possess antiseptic properties and application has 
been made of this fact^ especially in the treatment of 
variola. The dose, when adminsstered internallyj is 
30 to 45 grains given in wine. 

Zinc CHLORiD.—ZnCl.^. This substance, which is 
used in concentrated solution as an escharotic or caustic, 
also possesses antiseptic powers. Koch found that it 
had little or no effect upon anthrax spores, however, 
for such spores germinated even after thirty days im- 
mersion in a five per cent solution. A five per cent 
solution successfully destroyed the spoies of Bacillus 
subtilis, A two per cent solution destroyed pus cocci 
in two hours while a .5 percent (1:200) solution de- 
stroyed the Micrococcus Pasteur i in the same time. 
Miquel has determined that the substance is antiseptic 
in the proportion of 1 :526. 

Zinc-^Mercuric CYANiD.~Hg(CN),,4Za(CN),. This 
substance occurs as a white powder which is practically 
insoluble in water. It has been highly recommended 
as a non-irritating antiseptic but its use has not become 
general. Until recently it was the favorite antiseptic 
used by Sir Joseph Lister, the ^*Father of Antiseptic 
gurgery"; more recently, however, he has repudiated all 



219 

antiseptics^ with the exception of carbolic acid — this he 
deems the antiseptic /^r excellence. The chief objection 
to zinc mercuric cyanid is its feeble germicidal power, 
owing what virtue it possesses to its inhibitory power. 
(See "Mercury.") 

Zinc Sozoiodolate. — This substance is the zinc de- 
rivative of sozoiodol (which see). It occurs in the form 
of acicular crystals which are soluble in water in the 
proportion of 1:20. It has been used in acute and 
chronic blenorrheas and also in acute inflammatory con- 
ditions of the naso-pharynx. In gonorrhea it is em- 
ployed in aqueous solutions of strengths of .5-1.5 per 
cent, to which either laudunumn or salicylate of bis- 
muth may be added. 

Zinc Sulphate. — ZnSO^. This substance occurs in 
crystals or crystalline masses which are readily soluble 
in water. The product is used chiefly as a mineral 
astringent or an irritant emetic. Some physicians have 
attributed antiseptic or germicidal powers to it. Koch 
found that anthrax spores germinated even after ten 
days immersion in a five per cent solution. Micrococci 
from an acute abscess resisted the action of ten to 
twenty per cent solutions even after exposures of two 
hours — the Micrococcus tetragenus was killed however. 
A careful consideration of all of the experimental data 
at our command leads us to the conclusion that the 
substance has very feeble, if any, germicidal power. 

Zinc Sulphocabbolate. — This substance is the zinc 
salt of sulphonie acid, also termed sulphocarbolic or 
phenyl-sulphuric acid. (See sulphocarbolic acid)^ Thi§ 



220 

salt was at one time highly vaunted as an intestinal 
antiseptic. Koch found that a five per cent solution 
failed to destroy anthrax spores even after five days 
exposure— the sodium compound was equally worthless, 
even when applied for a greater length of time. 

Zinc Sulphydroxid. — Zn(SH),. Theoretically this 
substance is the hydroxid in which the oxygen of the 
radical hydroxyl has been displaced by sulphur. Zinc 
sulphydroxid occurs as a white solid which readily de- 
composes in the dry state and is therefore frequently 
preserved by immersion in water. It has been employed 
both internally and externally. Its use in external 
treatment has been chiefly in such conditions as psori- 
asis, eczema and various dermatoses of a vegeto-para- 
sitic character. It can be used externally in the form 
of an ointment of the strength of ten per cent. Inter- 
nally it is administered in doses of one-half to two 
grains, usually in pill form. 

VIII. — Their Use and Value in General 
Medicine. 

What have the principles of general antisepsis done 
for general medicine? Have not their far-reaching in- 
fluences been felt even here? To-day the modern sci- 
ence of bacteriology is about to revolutionize modern 
medicine and its principles — indeed we seem upon the 
eve of a dawn of the elaboration of a specifiic and radi- 
cal treatment for disease, infectious diseases at least. 
In some cases this seems to have been acoomplished al- 



221 

ready while in others a vast stride has been made in 
such direction by the demonstration, isolation and study 
of the various specific organisms upon which the etio- 
logy of these diseases seem dependent. While much 
has been accomplished in this field, it is chiefly in the 
sphere of preventive medicine, of praphylaxis, that the 
harvest has proven richest and most abundant. In the 
case of pulmonary tuberculosis, one of the most fatal as 
well as common of all diseases, the specific cause of the 
disease has been discovered, isolated, cultivated and 
studied. This has led to the demonstration that infec- 
tion in many cases is largely due to the dessication and 
dissemination of tuberculous sputa as an impalpable 
powder. 

A proper appreciation of the infectious and dang- 
erous nature of the sputum has led to its destruction or 
sterilization. The result of this has been seen in some 
localities, where extended observations were made, in a 
reduction of the death-rate of the disease. When we 
consider the extent of the disease and its essentially 
fatal character, we can readily appreciate the fact that 
even a slight reduction in the mortality is as significant 
as important, indicating as it does the possibility of 
more than a slight saving of human life the world over. 
While the disease itself is by no means thoroughly 
amenable to treatment, yet its inception has been to 
some extent avoided by the destruction or sterilization 
of the infectious discharges (sputa) from those thus 
affected. Moreover attempts at internal and local treat- 
ment of th^ diseased oondition^ although ha-rdly brill ^ 



222 

iantly encouraging, have not been altogether devoid of 
result. Of course in all treatment it must constantly 
borne in mind that the destructive action of the blood 
and tissues upon parasitic organisms is appreciably 
decreased by conditions of mal-nutrition and depressed 
vitality; or by surroundings unfavorable to the most 
healthy development of the body and its organs and 
tissues. By improving nutrition and placing the patient 
in the most favorble hygienic conditions which are per 
se least favorable to micro-organic development, we in- 
crease the germicidal power of the blood and tissues 
and their toxicity for tubercle bacilli as well as other 
bacteria. 

To hygiene, to quarantine, to sanitary science, anti- 
sepsis and bacteriology (its logical outcome) have prov- 
en of the utmost value — indeed upon this rock are they 
noV founded. Typhoid fever, Asiatic cholera and vari- 
ous other epidemic and infectious diseases have had 
their virulence comparatively circumscribed by rigid 
adherence to the dicta of antisepsis, especially by the 
complete disinfection of stools and other infectious dis- 
charges from those afflicted. This has been of decided 
value; when one is unable to control an infectious dis- 
ease itself, it is of the utmost importance and value to 
be able to control the spread of the disease. It is diffi- 
cult to estimate the absolute value of such power, be- 
cause such value depends upon the casualties and fatali- 
ties averted, therefore it must remain an unknown yet 
indubitable quantity or factor. To what did we owe 
our freedom from the terrible scourge of cholera a few 



223 



years ago but to the prompt institution of rigid sanitary 
and hygienic — that is, antiseptic— precautions? Indeed 
scientifiic men are so familiar with the abundant and 
practical results of the application of antiseptic princi- 
ples in preventive medicine that is hardly seems necess- 
ary to do more than direct attention to them. Certainly 
they are as manifest as the successes of the use of anti- 
septics in variou^i traumatisms and in the treatment of . 
localized infectious conditions where accessible to local 
treatment. 

Moreover bacteriology, the legitimate offspring of 
antisepsis, has also added greatly to the precision of 
diagnostic skill and science. What nosological chain 
of evidence is now complete and positive, in tuberculosis, 
that is devoid of a demonstration of the presence of the 
specific bacillus in the morbid secretion? What diag- 
nosis of Asiatic cholera is a completed scientific entity 
at the present day unless the presence of the character- 
istic spirilla in the alvine discharges has been demon- 
strated? How indeed may we clearly and positively 
differentiate between diphtheria and several other in- 
fectious, inflammatory, membranous or pseudo-membran- 
ous diseases of the naso-pharynx except by a bacter- 
iological demonstration of the presence or absence of 
the Klebs-Loeffler bacillus? 

In the earlier days of even modern antisepsis sub- 
stances were frequently employed which later and riper 
experience has proven devoid of value. The beginning, 
of all systems are necessarily crude, it is the oft- repeated 
story of per aspera ad astra. In the utter absence of 



224 

precise knowledge concerning the nature of the infect- 
ing agent, or germ, or its habits as well as habitat, it 
was not surprising to find the sanitarian devoting him- 
self to futile efforts at destruction of imaginary foes 
with weapons almost as imaginary. For this same rea- 
son he frequently neglected to attack the much more 
material and infectious pathogenic principles of such 
. things as tuberculous sputa or typhoid or choleraic ex- 
creta. We have now learned however that even if 
pyogenic and pathogenic bacteria do exist in the air 
(which is not to be doubted) the spray, as Stimson has 
amply shown, is thoroughly incapable of effecting their 
destruction. By far the greater danger of infection 
lies in the transfer of germs directly to the wound sur- 
face or other focus of infection by means of infected 
hands, instruments or dressings. Indeed in many cases, 
formerly, the physician or surgeon was himself the un- 
suspected and unconscious source of infection. Now 
howev'er everything unsterilized is looked upon as a 
possible source of infection. 

The vital resistance of bacterial organisms to various 
agents differs within certain limits for the various 
species; some exhibiting special susceptibility to special 
agents, for example that of the septic micrococcus to 
alcohol and of the Bacterium terrao to boracic acid. 
There is therefore certainly some rational basis for the 
supposition that the various pathogenic germs may like- 
wise exhibit similar susceptibilities to various agents 
administered medicinally with a view to the destruction 
of such germs, or rather to a prevention of their devel- 



225 

opment. The antiseptic value of the substances so 
tested depends larpjely, indeed entirely upon their 
power to prevent the multiplication and proliferation of 
bacteria. This does not necessarily imply germicidal 
power, which it. would hardly be within the bounds of 
reason to expect in internal administration. Indeed 
Sternberg has claimed that it is possible that the virture 
of mercuric chlorid and iodid in syphilis may be due to 
the restrictive power of even the small quantities of the 
drug exhibited. It would be impossible to introduce 
sufficient to ^i7^ the germ but he thinks it plausible at 
least that a sufficient quantity may be ingested to re- 
strict its growth and development. Some agents which 
do not actually kill micro-organisms nevertheless pos- 
sess considerable restrictive power and by virtue of this 
property become valuable antiseptics, this is especially 
true of boracic acid. 

Clinical experience has demonstrated the value of 
various antiseptics which have been used experimentally 
in the treatment of various diseases in which there was 
reason to even suspect the presence of specific organ- 
isms. Indeed there are few practitioners who have not 
employed these agents internally for the cure of various 
forms of disease. In some instances their effect has 
been more or less prompt and satisfactory; in others 
probably only negative results have been attained while 
in a third class perhaps only toxic and untoward devel- 
opments have arisen. In view of this diversity and 
varience in both results and opinions perhaps a discus- 
sion of the proper uses and limitations of antiseptic 



226 



remedial agents, however brief or imperfect, may not 
be entirely out of place. Let us look at our facts in the 
light of the developments, established by both experi- 
ment and experience, of the past few years. It has been 
demonstrated beyond doubt that most of the infectious 
diseases at least are due to (a) specific organisms or (b) 
substances produced by the action of specific organisms; 
and that most, if not all, of these diseases are accom- 
panied by more or less pyrexia. In many of these cases 
the specific organism has been isolated and determined, 
as is the case with the following: 



Morbid Condittoj»^s. 
Suppuration. 



Gonorrhea. 
Anthrax, 
Tuberculosis. 
Leprosy. 
Glanders. 
Typhoid fever. 
Tetanus. 
Influenza. 
Diphtheria. 
Specific croupous pneu- 
monia. 

Asiatic cholera. 
Relapsing fever. 
Epidemic dysentery. 
Erysipelas 



Micro Organisms. 
The various pus cocci 
such as Staphylococcus pyo- 
genes aureus^ albiis^citrus and 
the Streptococcus pyogenes. 
The gonococcus of Neisser. 
Bacillus anthracis, 
" tuberculosis. 
" leprce. 
" mallei* 
" typhosus. 
" tetania 
" influenzce. 
" diphtherice. 
Diplococcus pneumonia?. 

Spirillum cholerm. 
Spirochaete Obermeieri. 
Ameba dysentericB. 
Streptococcus erysipelafis. 



227 

Then too certain other diseases such ag variola, rubeo- 
la, scarlatina, yellow fever, typhus fever, syphilis. Ori- 
ental plague and several intestinal diseases are also in- 
fections in nature and doubtless have specitiic organisms 
which have not as yet been isolated. Let us glance 
briefly at these conditions. 

In the case of suppuration the virtue and value of 
antisepsis is peculiarly marked. In a properly conducted 
treatment of a localized and accessible condition the 
formation of pus is now practically as rare as it was 
formerly common. Indeed as Gerster says, at the pres- 
ent day infection and suppuration in a fresh wound are 
due to technical faults or else errors of commission 
or omission on the part of the professional attendant in 
charge. 

Anthrax and glanders are more commonly confined 
to the lower animals and hence have little interest 
to us in a consideration of the method and results of 
antiseptic treatment. 

In the more modern and successful treatment of gon- 
orrhea the tendency is to the use of irrigant antiseptic 
solutions of boracic acid, mercuric chlorid, potassic 
permanganate and hydrogen peroxid. In such cases 
the results given have been more than satisfactory. In- 
deed sterilization of the lower genito-urinary tract has 
been accomplished, it is even claimed, by the internal 
administration of such remedies as oil of wintergreen or 
boracic acid, Johnson had proven the appearance of bo- 
racic acid in the urine ten minutes after its administra- 
tion by the mouth. 



228 

In the case of influenzaj variola, rubeola, scarlatina, 
yellow fever, typhus fever and relapsing fever little or 
no benefit has been ascribed as yet to internal antiseptic 
medication, except in the case of influenza which some 
claim is distinctly modified by the inhalation of vapor- 
ized volatile antiseptics. In scarlatina also antiseptic 
inunctions in the latter stage have lessened the chances 
of infection of those coming in contact with the patient. 

Epidemic dysentery, so long beyond the control of 
the physician, has at last been found more or less amen- 
able to antiseptic rectal injections, especially of aqueous 
solutions of argentic nitrate. 

Diphtheria is now recognized as an infectious disease 
of a local nature whose general symptoms are due to 
secondary absorption of the products of vital activity 
on the part of the germ. Its treatment is essentially 
antiseptic, being directed against the germ lodged in 
the membrane. The results of such treatment are so 
obvious that we need hardly do more than refer to them. 
The same is also true of erysipelas, whose streptococcus 
seems to be specially susceptible to the influence of 
carbolic acid. In Asiatic cholera it has been noticed 
that the spirilla are especially susceptible to the effect 
of the mineral acids, even in dilute solutions. Advant- 
age has been taken of this fact in the treatment of the 
disease and it has also been combined with intestinal 
irrigation. 

In the case of tetanus Dr. Schwarz, of Padua, cured a 
boy of the disease by means of the injection of an anti- 
toxin which had been prepared by Tizzoni and Cattani 



229 

from the specific bacillus. Schwartz likewise refers to 
three other similar cases which had been treated by 
Italian physicians in a similar manner with the success- 
ful result in each case. Fraenkel had a similar experi- 
ence in diphtheria. 

It is now established beyond doubt that typhoid fe- 
ver is caused by a specific organism introduced from 
without. Eberth found the bacillus present in the 
spleen, lymphatic glands and portions of the intestinal 
tract in twelve out of twenty-three cases, Koch in fifty 
per cent and Meyer in sixteen cases out of twenty. 
Lucatello reproduced the disease in ten out of thirteen 
cases by inoculation with blood from the spleen of a 
diseased animal. Neuhaus found the bacillus in the 
rose maculas in nine out of fifteen cases. The chief seat 
of the disease is in the intestinal tract. It hardly seems 
rational to claim to be able to Mil the germ under such 
surroundings, but can we not sweep the fecal matter 
from the bowel and by the use of proper antiseptics 
prevent the development and proliferation of the germ 
within the intestinal tract? The experiments of Fort- 
chinskey are interesting in this connection. He used 
from ten to fifteen grain doses of boracic acid in two 
hundred and forty cases of typhoid fever during an 
epidemic; he was successful in two hundred and thirty- 
one cases — about ninety-six per cent. He claims that 
in the first three or five days fever and diarrhea dimin- 
ished, tympanitis almost disappeared and the stools be- 
came normal in character. 

It is hardly necessary at the present time to offer 



230 

proofs of the existence of ptomaines and toxalbumins, 
this has long since been done by many competent and 
reliable observers. Indeed such substances may be real 
causative factors in disease or in the causation of dan- 
gerous and disagreeable symptoms. Such ptomaines or 
toxalbumins may originate either externally or inter- 
nally, in either event their ingestion and absorption are 
more or less promptly followed by various acute pheno- 
mena resembling ordinarily the profound symptoms of 
acute alkaloidal poisoning. In many cases the disease 
may be primarily local but soon becomes constitutional, 
a result of the secondary absorption of the products 
eliminated by the germ in its life history. And the 
manifestations of this secondary or systemic infection 
are often more alarming and more dangerous than those 
of the primary local infection. After this general in- 
fection has taken place the local use of antiseptics is 
useless except in the attainment of a purely local result. 
The disturbing element is no longer circumscribed, it 
has now penetrated within the portals of the circulation 
whither we can hardly follow it, for the agent which by 
its toxic power has paralyzed the nervous system and 
threatens every function is quite beyond thh reach of 
germicides— it is amenable to no antiseptic. The cause 
is not an organism whose vitality may be destroyed, it 
is a definite compound whose physiological effects must 
be combated or whose chemical autonomy must be de- 
stroyed. After ptomaines, leucomaines or toxalbumins 
are formed they can hardly be antagonized by germi- 
cides, the germ must be destroyed before elaborating 



231 

the substances. In other cases perhaps the germ itself 
may enter the circulation, leaving the site of primary 
infection; it is then inaccessible and proof against at- 
tacks of this nature. If in this latter case the future treat- 
ment of infectious disease is to be directed to specific 
germs rather than to the resulting phenomena we shall 
be forced to rely not upon mechanical destroyers but 
upon proteids or alkaloids which are either chemically 
or physiologically antagonistic, as well as to institute 
treatment with a view to an increase of the vital resistive 
power of the tissues and fluids. Here is the field of the 
medicine of the future. Germicides are only of value 
in so far as they destroy germs and prevent future 
elaboration of toxic products. Clearly then the infer- 
ence is obvious — action must be taken sufliciently early 
to destroy the germ and render impossible secondary 
infection by absorption of toxic products. 

In such diseases as are dependent upon secondary in- 
fection our main reliance as yet is to 'be placed in those 
remedies and measures which support and stimulate 
the vitality of the patient and promote his nutrition — 
"6?a robur^ fer auxilium,^^ 

It can be positively stated that fermentative or putre- 
factive micro-organisms do not exist actively in the in- 
testinal tract when its secretions are normal. Kurlow 
and Wagner have proven conclusively that constant or 
specific microbes do not exist in the stomach and 
that those which do enter it with the ingesta are only 
accidental abd temporary residents for they cannot live 
in the normally acid contents of that organ. In their 



232 

opinion the normal gastric juice is indeed an exceed- 
ingly strong germicidal agent and when in full and nor- 
mal activity destroys all others than the most prolific 
and tenacious germs, such as the bacilli of tuberculosis 
and anthrax; certain staphylococci also seem to be able 
to withstand its action. So Nature provides, as it were, 
a Cerberus to guard the portals of the alimentary tract or 
rather indeed to fortify its whole course, just as in her 
beneficence she has conferred germicidal properties up- 
on the blood, certain fluids and the cellular elements, 
or their constituents, of certain organs. 

If then the normal intestinal and gastric juices possess 
such desirable and valuable attributes may we not con- 
clude that the vast majority of cases of infectious dis- 
ease of such tract are direct results of a vitiation of or 
deficiency in the quality of each secretion? If such be 
the case then scientific therapeusis demands the de- 
struction and elimination of infectious material by the 
institution of normal processes elaborating normal se- 
cretions as well as, if not more than, the direct antagon- 
ism of antiseptics themselves. Antiseptics may be of 
decided value however when they have the power of 
ridding depressed vitalities of the incubus of germ life. 

While large numbers and varieties of micro-organ- 
isms do exist normally in the digestive tract they are 
ordinarily incapable of injurious action because they are 
rendered inert by the normal digestive fluids. But the 
moment, however, that such normal secretions, become 
perverted, vitiated or arrested the germs already there, 
or those introduced with the ingesta, are placed under 



233 

conditions favorable to their development and as a con- 
sequence fermentative changes ensue. Once instituted 
who can foresee the result? Will it be simply a case 
of primary and local infection or will it result in a more 
complex and dangerous secondary and systemic infec- 
tion? This depends entirely upon the nature of the 
germ or germs and also the facilities present which are 
favorable or unfavorable to successful and undisturbed 
development. When only a single local infection 
supervenes it may be and is possible by the use of 
proper antiseptic measures and the administration of 
proper antiseptic remedies in sufficient quantities to 
limit or arrest the morbid condition. Not always by 
destroying the organisms themselves, but by instituting 
a train of conditions unfavorable to their subsequent 
growth and development. This must, however, remain 
little else than palliative and temporary in effect so long 
as the secretions of the digestive tract are at fault and 
allowed to remain so. Furthermore we can anticipate 
little else than unsatisfactory results as long as we ex- 
pect a small amount of antiseptic, such as is hardly more 
than sufficient to sterilize a superficial ulceration, to 
promptly,' thoroughly and sufficiently disinfect the whole 
intestinal tract with its many square feet of mucous 
membrane, to say nothing of the accumulated infected 
secretions and excretions. Catharsis, elimination and 
irrigation must precede and mechanically prepare and 
make clean the way for the antiseptic which is to fol- 
low— that is, a minimum amount of work should be left 
for it. 



234 



IX.— Thbir Value and Use in Surgery. 

The primary elucidation of the principles of antisepsis 
originated with the surgical branch of the healing art 
and it is but natural that we should look to this depart- 
ment of medical science for subsequent development 
and improvement. Have our expectations been realized 
or has Time, with ruthless hand, swept all record from 
the history of progress? Nearly three decades ago the 
principles of antisepsis first came into practical use in 
surgery and the subsequent history of those principles, 
from the very first period of their inception, has been 
one of continual and uninterrupted progress. Within 
the past few years the results of bacteriological research 
have completely revolutionized surgical pathology and 
surgical methods. A large majority, if not all, of the 
acute and chronic inflammatory processes and lesions, 
as well as wound complications, which are brought to 
the attention of the surgeon are due to micro organisms. 
For this reason it is necessary and expedient that the 
importance of bacteriology as an integral portion of the 
science and art of modern surgery be given due and 
proper recognition. These recent advances in surgical 
pathology, involving surgical methods as they did, laid 
the very foundation for those brilliant achievements of 
modern surgery which read like the pages of a medieval 
romance. The debt which modern surgery owes to 
bacteriology and bacteriological research is peculiarly 
great, for to it must be accredited a large measure of 



235 

the success attendant upon its later years. The knowl- 
edge which has been derived from the systematic inves- 
tigation of disease, impelled by the aid afforded by bac- 
teriology, has opened new fields of usefulness and mater- 
ially extended the sphere as well as increased the utility 
of the surgeon himself. Indeed to such good effect 
that many conditions formerly and vainly treated by 
medication are now speedily and successfully obviated 
by the art of the surgeon. 

In the olden days operations were performed, it is 
true, upon the various cavities, cranial, thoracic and ab- 
dominal; but such cases, for reasons which are now ob- 
vious, were so speedily and uniformly terminated by 
death from septic causes that intrepid indeed must be 
the heart and hand which dared stand undaunted in the 
very face of assured disaster. The values of antisepsis 
and asepsis were less than vaguely known and appre- 
ciated and though such conditions were at times some- 
what imperfectly obtained this was rather the result of 
chance than design. The bravery and no less the suc- 
cess of a McDowell under these conditions, with a howl- 
ing mob on one side and a fearful operation with a still 
more fearful outlook as to mortality on the other, was 
little else than marvelous and phenomenal. This ex- 
ceedingly hazardous chance of success has been entirely 
obviated by modern methods; the sanctum of the human 
body is now devoid of any sanctum sanctorum within 
which it is forbidden the invading hand of the surgeon 
to enter— the very centers of life and function are ap- 
proached with little or no fear of untoward consequences. 



236 

This confidence is not the child of audacity but the off- 
spring of confidence and success. Abdominal surgery 
has sprung into bud and blossom beneath the kindly in- 
fluence of modern aseptic and antiseptic methods. The 
thoracic cavity is invaded and no ill result is anticipated. 
Cranial surgery is now a sturdy youngster though only 
of some seven or eight summers. Cerebral localization 
is the logical outcome of modern methods of research 
and the spirit instituted has stimulated cerebral surgery 
to renewed strength. All of these triumphs were possi- 
ble only upon one contingency — complete and thorough 
antisepsis, which of course includes asepsis. 

But the greatest achievement of modern surgery is 
not so much in the triumphs of either abdominal or 
cerebral surgery; nor indeed of any one or more partic- 
ular classes of operations. This lies in the method which 
has brought every organ within the domain and under 
the influence of the surgeon— it forms the very founda- 
tion upon which the superstructure rests. The victory 
and success of that method manifests itself no less in 
recovery from the simplest operation than in that from 
laparotomy or craniotomy or the extirpation of a cere- 
bral tumor without the formation of pus or the develop- 
ment of pyrexia. So great is the importance of this 
method that the introduction of antisepsis marks the 
dawn of modern surgery. The value of the service 
which Lister had rendered mankind was exemplified 
when Qaeen Victoria conferred knighthood upon him. 
This was honor, this was glory — but the unfading and 
imperishable glory of Sir Joseph Lister's life is to have 



23t 

ushered in an era which has snatched life from death 
in that it has so markedly reduced the mortality of man- 
kind in so far as death by unnatural septic means is con- 
cerned. He recognized and appreciated the fact that 
wound infection is dependent upon the presence and in- 
fluence of micro organisms. But he did much more 
than this, for he adopted measures of treatment based 
upon this truth; he not only recognized the evil and ap- 
preciated its source but also formulated a systematic 
method of combating these microscopic yet omnipotent 
as well as omnipresent foes of the surgeon. His fame 
will rest safely and securely upon the establishment of 
these fundamental /r/^^^^^/^i" even if every detail of his 
original method be supplanted by better ones. Indeed 
this has taken place to some extent already and will 
probably continue to do so. The original spray and 
dressing Lister has now discarded himself, explaining 
that these were but the essential crudities which occur 
in the development and perfection of any system. But 
Wi^ principles upon which they were founded remain ab- 
solutely unaltered and unshaken in every particular; 
for of a truth, the elapse of time and the accumulation 
of experience all bear testimony to, as well as strength- 
en, their unassailable position. The antiseptic and 
aseptic methods depend no less upon the researches of 
bacteriology than upon clinical experience — indeed, in 
the development of these methods both work together 
hand in hand, the one announcing principles which the 
other puts into practice. As Dr. Edwin Hamilton has 
most aptly said: **The surgery of to-day seems ele- 



§38 

vated on a tripod of three solid enduring feet — they are^ 
anesthetics, antiseptics and experimental research." 

The stage of controversy as to the value of the 
methods of antisepsis and asepsis has long past, for, 
with the exception of a very limited number of individ- 
uals the surgical world is unanimous in its unqualified 
approval of the method which has yielded so many 
brilliant results. Moreover those very few who affect 
to dispute the efficacy of the principles make use of them 
by different methods. Any procedure made with a 
view to the exclusion of germs is metaphorically and 
literally an antiseptic procedure. Lawson Tait who bit- 
terly and maliciously assails not only Lister's methods 
and principles but his very personality also, completely 
sterilizes every instrument or dressing by the antiseptic 
action of heat; his excellent results are due to a rigid 
and thorough application of these principles — yet 
he piously raises his hands to Heaven and renders 
thanks that he is not as other men are. As Dr. 
J. William White aptly says, the animus of his attack 
is shown when Tait naively says that Lister has com- 
pletely ignored him ind his results for the past twelve 
years. Bantock owes his results to precautions identi- 
cal with these of Tait. Their mortality records are 
low, it is true,— 4 per cent in Bantock's practice and 
3.3 per cent in Tait's practice. But Thornton, a country- 
man of Tait, working under the same conditions and in 
the same field of work, has^ by a judicious combination 
of antisepsis and asepsis, obtained the marvelonsly low 
mortality record of 1.88 per cent—a distinct and signal 



239 

gain over both Bantock and Tait, Bantock's mortality 
being 122 4-9 per c?nt greater and Tait's 83 1-3 per 
cent greater than that of Thornton. These results have 
also been attained by Price and others of our own 
country. 

The clinical and bacteriological proof that suppura- 
tion, pyemia, septicemia, erysipelas and other similar 
complications are due to the presence and influence of 
micro organisms is practically absolute. Lister has 
said: "The germ theory of putrefaction is the founda- 
tion of the whole system of antiseptic surgery, and if 
this theory is a fact, it is a fact of facts that the antisep- 
tic system means the exclusion of all putrefactive or- 
ganisms." This theory is founded upon a mass of cor- 
related and substantiated facts, experimental, clinical, 
physiological, pathological and bacteriological in char- 
acter; these are sufficient to establish it upon a firm and 
substantial basis. But the time for controversy is past; 
\kiQ principles are indubitably established — the only de- 
batable ground is as to the selection of methods of carry- 
ing out those principles and as to the perfection of 
details. The constant and thorough researches of pa- 
tient and trustworthy investigators have but confirmed 
Lister's statement in every degree. The clinical proof 
is equally strong. The statistics of all operations, 
major and minor, in the preListerian period as con- 
trasted with those of the past two decades, establish 
the fact that those septic diseases which were rife in 
private, but more especially hospital practice have al- 
most entirely disappeared. Formerly these diseases 



240 

Blew thousands and tens of thousands, but now the mor» 
tality from these causes is almost nil and the diseases 
themselves have been almost entirely banished. Form- 
erly surgeons attempted to produce suppuration and to 
prevent primary union; modern surgery teaches us to 
secure primary union and to prevent the occurence of 
suppuration — indeed the formation of pus is looked up- 
on as a tangible cause for reproach to the surgeon in 
charge. Compound fractures, which were formerly 
among the most dangerous of accidents, are now scarcely 
more so than simple ones. The rate of mortality con- 
sequent upon amputations and abdominal sections has 
fallen nearly to zero. Formerly recovery in such cases, 
especially in abdominal section, was hoped for and fond- 
ly hailed as an evidence of superior skill on the part of 
the surgeon. At the present day recovery is not simply 
hoped for but confidently expected as a matter of course 
—the operator not only deserves success but he also 
commands it. 

The history of the development and establishment of 
this great theory which has so profoundly influenced 
the progress not only of surgery but the whole of med- 
ical science as well, is the result of the labor not of one 
but of hundreds of the world's choicest intellects; it 
constitutes one of the brightest of all the chapters in 
the record of human progress. It belongs to no one 
nation exclusively but is the common property of the 
civilized world, for it has been at once an evolution and 
a revolution in the complete consummation of which 
all nations have shared. In Germany and France 



241 



Schwann and Pasteur demonstrated that putrefaction is 
due to the presence of micro-organisms. In Scotland 
and England Lister applied this fact to surgery, demon- 
strating that the statements of Schwann and Pasteur 
hold true also in the case of living flesh. In the United 
States, Austria and Germany further applications and 
perfections of technique have been attained; while in 
the United States, France, Germany, Great Britain, 
Italy and Russia immense strides have been made in the 
direction of the development of bacteriology and surgi- 
cal pathology. 

But let us glance briefly at some of the benefits 
which the principles of antisepsis, which naturally 
include those of asepsis, have conferred upon humanity. 

In the period of 1864 to 1866 inclusive. Lister op- 
erated in the city of Glasgow. The mortality in this 
series of operations of all kinds was 45.7 per cent; these 
deaths were largely due to septic complications and dis- 
eases. In the period of 1867 to 1869 inclusive he began 
gradually to employ his antiseptic methods and the 
mortality sank remarkably— to 15 per cent! This meant 
that whereas pervious to the use of his antiseptic 
method only slightly more than one-half of his patients 
survived, under its use about six sevenths survived. He 
began to improve the details of his system and moved 
to Edinburgh. During the period of 1871 to 1876 in- 
clusive he treated five hundred and fifty-three grave 
surgical cases with a mortality from septic conditions 
reduced to — .36 per cent! Thus in twelve years his 
mortality rate dropped from 45 7 per cent to .36 per 



342 

cent; without antisepsis it was i^7 times as great as with 
ite This diminution is so startling and so striking that 
when we remember that the different results were ob- 
tained by the same operator upon the same class of pa- 
tients for practically the same injuries or diseases, they 
seem, ipso facto^ not only conclusive but little short of 
the marvelous. 

Somewhat later the methods of Lister and those cur- 
rent before the introduction were subjected to compari- 
son. He, with antiseptic precautions, and Spence, with- 
out antiseptic precautions, worked in the same hospital 
upon the same class of patients for practically the same 
conditions. Spence lost three times as many patients as 
Lister. In deaths from infectious disease Lister had a 
mortality record of .33 per cent, while that of Spence 
was 2.4 per cent, or nearly eight times as great as that of 
Lister 1 

But these results were not peculiar to the practice of 
Lister, the originator of the system; they were corrobo- 
rated and confirmed by every impartial observer and 
operator. Nussbaam has distinctly and expressly stated 
that in the forty years experience in his clinic, under 
himself as well as his predecessors, deaths from wound 
diseases and wound complications were so common, 
prior to the introduction of antiseptic methods, that 
even those patients with the slightest injuries frequently 
succumbed to them. He furthermore stated that dur- 
ing this same period erysipelas and abscesses were mat- 
ters of daily occurrence, that 80 per cent of all wounds 
and sores were attacked by hospital grangrene and that 



us 

nearly all cases of compound fracture terminated in 
death. But immediately upon the introduction of the 
antiseptic method all of these diseases suddenly disap- 
peared and healing by first intention, previously almost 
unheard of in his serviee^ became the rule instead of the 
exception. His statistics also show that while for six- 
teen years previously hospital gangrene, erysipelas, 
pyemia and septicemia had never been absent from the 
wards of the Munich General Hospital they suddenly 
vanished upon the introduction of antiseptic methods of 
wound treatment. 

Volkmann states that in his practice the mortality in 
compound fractures was above 40 per cent. Immedi- 
ately before he adopted antiseptic methods he had 
twelve cases of compound fracture, every one of which 
was terminated by death from septicemia or pyemia. 
He had become so discouraged by the alarming mortali- 
ty from septic causes, the prevalence of gangrene, ery- 
sipelas, pyemia, septicemia, etc., that he declared his in- 
tention of closing his hospital. As a dernier ressort he 
tried the methods of Lister. From that time until the 
year 1881 he had in all 135 cases of compound fracture 
with not a single death from septic causes!~lSB out of the 
135 completely recovered; of the remaining two, one 
(a drunkard) died of delirium tremens, the other of fatty 
embolism of the lungs within two hours — before treat- 
ment had been fairly instituted. This means that only 
one death was directly due to compound fracture and 
even then by an unfortunate accident which can hardly 
be averted. In his practice previously, with a mortali- 



Mi 

ty of more than 40 per cent, he would have lost 58 pa- 
tients. This means that in his experience with antisepsis 
in compound fractures up to the year 1881 he had saved 
51 lives which would have otherwise been needlessly 
sacrificed. Contrast the mortalities — more than 40 per 
cent on the one hand, .74 per cent, three-quarters of one 
per cent, on the other. That is, this mortality without 
antisepsis was nearly fifty-eight (58) times as great as 
his mortality with it. What a parallel! The figures 
speak more forcibly than words. It is needless to say 
that Volkmann did not close his hospital, far from it — 
he became one of the sincerest admirers of Lister and 
one of the staunchest advocates of his system. 

Monsieur le Docteur Briquot shows in his statistics 
that the mortality in the French hospitals after major 
operations had been 52.5 per cent before the introduc- 
tion of antiseptic methods, but that the introduction of 
antisepsis lowered the death rate below 11 per cent. 
In the Pennsylvania Hospital there were 116 cases of 
compound fracture treated in the period 1839 to 1851. 
In these, excluding those requiring amputation, there 
were 51 deaths — a mortality of 44 per cent. In the 
New York Hospital, during the same period, there were 
126 cases treated; in these, excluding amputations, there 
were 68 deaths — a mortality of 48.4 per cent. In the 
surgical clinics of Vienna and Zurich, during the period 
1860 to 1876 and prior to the use of antisepsis here, there 
were reported by Billroth 180 cases of compound fract- 
ure with a mortality, excluding amputation, of 41 per 
cent. In the Obuchow Hospital of St. Petersburg, 106 



215 



cases gave a mortality of 68 per cent. In Guy's Hospi- 
tal, London, there were, during the period 1841 to 1861, 
208 cases with 50 deaths— a mortality of 24 per cent. 
It is but justice to whom justice is due to say that I have 
obtained many of the statistics above quoted, from a 
masterly and scholarly article upon antisepsis by no less 
an authority than the well-known surgeon of Philadel- 
phia, Dr. J. William White. An analysis of the 736 
cases would give us an average mortality of 45 per cent 
before the use of antiseptic principles and methods; this 
corresponds with the statement of Volkmann that in his 
practice the mortality in compound fracture was more 
than 40 per cent. Upon the introduction of antiseptic 
methods it fell immediately to 4 per cent. That is, 
whereas in the 736 cases quoted more than 331 were 
terminated by death, such results under antiseptic pre- 
cautions would only occur in about 30 out of the whole 
number of 736 cases. At the present day, with the im- 
provements in methods, the mortality is still lower; 
now death is far more rare than it was formerly com- 
mon. Dennis recently reported 516 cases of compound 
fracture in which there was 'absolutely no death from 
septic causes. 

Dr. Thomas G. Morton in one of his Pennsylvania 
Hospital reports writes as follows: 

'^From the spring of 1875 to the same period in 1879, a 
period of four years, there were performed 108 ampu- 
tations upon 100 patients. Of this number 17 died. 
Five of these deaths took place within the first thirty- 
six hours following the admission of the patient, and in 



246 

each insoance from recurring or continuous shock. ^ ^ 
^ We are greatly pleased to be able to report that dur- 
ing the past five years there has not occurred in the sur- 
gical experience of the hospital a single case of pyemia. 
* * * We believe that this result is due to the very 
perfect system of forced ventilation by the fan, the 
scrupulous cleanliness of the wards, and the free use of 
carbolic acid in our dressings." 

It is of passing interest to note that by the year 1886, 
nearly eight years ago, the value of antiseptic measures 
had even forced its attention upon crowned heads, for in 
that year the King of Servia issued the following proc- 
lamation: 

"Whereas it is irrefutably proved by science that the 
so-called antiseptic trsatment of wounds yields more 
beneficial results than all other methods, we are pleased 
to order that henceforward the said antiseptic plan of 
treatment be solely employed in all the hospitals of our 
kingdom, and that corrosive sublimate and iodoform be 
used until our further disposition." 

Dr. J. Knowsley Thornton, the President of the 
Medical Society of London, in addressing that body, said : 
"I am not ashamed still to use the spray and all the pre- 
cautions which have advanced my results in ovariotomy 
to 1.88 per cent mortality (as against Bantock's 4 per cent 
and Tail's 3.3 per cent) and I find increased practice and 
a steady adherence to methods which have yielded me 
good results in the past, increase in like ratio my suc- 
cess in all abdominal operations. Every operator of 
prominence improved bis results enormously as soon as 



247 

he adopted Listerism; then having learnt how to be surgi- 
cally clean, he has found for himself ways of attaining 
this end with more or less success by methods differing 
from those of Lister. The sum and substance of it all 
is, that if we had never had Lister to teach us true clean- 
liness, we should never have used antiseptics, flushings 
or drainage tubes to attain it. The great advance is 
due to the antiseptic system, the minor details are 
merely the different ways of attaining the same end— 
asepticity. Time alone will show what is worth retain- 
ing and what we may safely cast aside." 

At least ninety per cent of the surgeons of the present 
day recognize the value of the modern methods of op- 
erative and wound treatment. When we consider the 
formidable array of statistics, the conclusions drawn 
therefrom and the lessons which they teach, it seems 
established beyond all cavil, question or doubt that 
thousands of lives have been saved every year by judi- 
cious application of the principles of Lister that would 
have been sacrificed by an application of those methods 
which were in vogue prior to the introduction of anti- 
septic surgery. If such an abundant measure of success 
has attended the treatment of accidental and infected 
wounds, how much greater should it be in operative 
work; here the wounds are inflicted by the surgeon him- 
self and under conditions which afford an opportunity 
of cleansing away most of the infectious material from 
the site of the operation. Thus the surgeon is enabled, 
as Fowler aptly says, *'to apply the ounce of prevention 
rather than be compelled, as in accidental wounds, to 
use the pound of cure." 



248 

It is now clearly the legal as well as moral duty of 
every individual who attempts the practice of surgery 
to prevent the access of germs to the wounds of his pa- 
tient by every means within his power. It is not a 
mere matter of choice, it is incumbent upon him, it is 
obligatory or else he must expect to bear the stigma of 
merited reproach. By proper care in the exercise of 
absolute surgical and bacteriological cleanliness this 
can be secured. As Gerster has said in his "Aseptic 
and Antiseptic Surgery." 

"The fear of suppuration with its dreadful conse- 
quences does not stay now the hand of the surgeon as 
of old, when an operation was always considered a for- 
lorn hope and a last resort. Strangulated herniae, for 
instance, are not allowed to gangrene as often as for- 
merly, and herniotomy is readily resorted to, as it is 
well known that the dangers of an aseptic herniot- 
omy done on a healthy gut are diminutive in compari- 
son to the certain and enormous danger of strangulation 
itself. 

By the conviction that a fault of omission may be 
followed by irremediable mischief, the sense of respon- 
sibility is stirred up to vigilance, which again breeds 
self-reliance and iBrmness of purpose in advising and 
carrying out incisive measures, made, clearly necessary 
by a well-recognized danger to life or limb. And an 
additional degree of responsibility is imposed by the 
very safety of aseptic operations. 

It can not now be successfully denied that the suT" 
geofCs acts determine the fate of a fresh wound^ and that 



249 

its infection and suppuration are due to his technical faults 
of omission or commission, 

* * ^ But he who becomes a master, to whom the 
primary healing of a fresh wound remains not a curi- 
osity but becomes a matter of course, will not doubt 
the great change that has come over surgery." 

If it was possible by the aseptic methods to secure a 
complete and absolute exclusion of the germ from the 
wound surface then the use of antiseptic substances 
would be entirely unnecessary. But this ideal condition 
is neither completely nor easily obtained for the opera- 
tor is continually liable to forget or neglect some minor 
detail or precaution which renders inutile all of the 
care hitherto taken; we must conjoin these precautions 
with the proper use of heat and antiseptics if we would 
secure further and proper protection. It seems strange 
to many how slight a discrepancy or flaw or lack of pre- 
caution may disturb the entity and success of aseptic 
methods; indeed it is exceedingly difficult to convince 
the majority of physicians (even those making use of 
proper precautions) that the touch of the completely 
sterilized finger or instrument to a non-sterilized ob- 
ject, such as one's own body or clothing or an assistant's 
clothing or a door-knob or an ansterilized instrument or 
dressing may vitiate the entire operation and seriously 
endanger success by the introduction of even a few 
microbic germs within the wound. For we must con- 
stantly bear in mind the remarkable fecundity of these 
lower forms of life, how a few solitary germs may 
within a very short space of time become many, many 
millions! 



S60 

We frequently hear of such discussions as "Asepsis 
vs. Antisepsis," or are greeted by the news that aseptic 
surgery is displacing antiseptic surgery — just as though 
these were two diametrically opposed systems or meth- 
ods. Aseptic surgery undoubtedly marks an important 
advance in the attempt to perfect surgical detail, but it 
is none the less antiseptic surgery. Antisepsis is that 
condition which is opposed to sepsis or putrefaction; it 
makes no difference whether the condition is obtained 
by destruction, inhibition or exclusion of the germ- 
putrefaction is prevented and that is the central and 
essential idea of antisepsis. The object of antiseptic 
surgery is to secure an aseptic condition in a wound. 
There is no opposition between asepsis and antisepsis, 
one is the logical outcome of the other. Although 
thorough and complete asepsis is the ideal of every sur- 
geon at the present day yet it is no less equally certain 
that the time has not arrived when we can afford to 
dispense with antiseptics. It is undoubtedly a fact that 
aseptic methods should be reserved for sterile or steril- 
ized wounds and not only to sterile wounds but to those 
in which we have reason to anticipate little or no dis- 
charge, with the accompanying risk of subsequent infec- 
tion and putrefaction of such discharges. In all other 
cases chemical antiseptics are necessary; in infected 
wounds asepsis is an impossibility. Indeed in a large 
proportion of those cases which come beneath the con- 
trol of the surgeon we need chemical sterilization of 
wounds and dressings as much as we ever did. There 
is as yet no good reason deduced for casting aside ut- 



251 

terly the weaker chemical solutions which are in use at 
the present time. Undoubtedly all antiseptic solutions 
which are sufficiently strong as to appreciably compro- 
mise the vitality of the tissues must be discarded; but 
those disagreeable effects upon the hands of the opera- 
tor and the tissues of the patient are usually only en- 
countered when solutions of too great strength are 
used—such as 1:1,000 of mercuric chlorid or 1:20 of 
phenol. This objection, as White says, applies with 
much less force to solutions of 1:2,500 of the one and 
1:40 of the other; these latter solutions experience has 
proven to be practically just as effective. 

However, we must not forget that surgical disinfec- 
tion has progressed not so much by the introduction of 
new and multitudinous antiseptics as by a better under- 
standing of the modes in which they act efficiently and 
the conditions which impair such efficient action. 

In the vast majority of cases organisms gain access 
to wounds by means of direct contact— that is, the germ 
is actually and materially conveyed to the seat of infec- 
tion. Nevertheless the possibility of infection from 
the matter floating in the air is not to be overlooked 
altogether, although the chances of infection from this 
source are certainly slight; careful experimentation has 
demonstrated that ordinarily the organisms exist in 
this medium in so slight a degree as to hardly merit 
serious consideration. This may be due to the antisep- 
tic action of light in combination with that of the at- 
mosphere, which antiseptic properties we have men- 
tioned in preceding papers; or it may be due to the fact 



252 

that the organic elements as well as the inorganic ele- 
ments of the atmosphere may be deposited finally as 
dust. Certainly settled dust^ especially that of hospi» 
tals, is comparatively rich in germs. In the collections 
beneath the nails, especially of surgeons and physicians, 
and in the rich soil of the epidermis, in the clotted 
blood and dried infectious discharges upon instruments 
we find an abundance of micro-organisms, pyogenic and 
pathogenic. Indeed in operative work their presence 
in the epidermis and their non removal or non-destruc- 
tion is one of the commonest and most potent causes of 
infection; then also the contact of non sterilized ob- 
jects, whether they be the hands of the operator or of 
the assistants, or whether they be the instruments and 
surgical dressings uged, furnish other palpable foci of 
infection. Or else absence of sterilization or imperfect 
sterilization favor the development of those organisms 
and substances which ultimately find their way into the 
wound itself where they encounter in abundance pabu- 
lum sufficient for their subsequent sustenance and by 
their presence and injurious action prejudice the natural 
operations of repair. It is much easier to destroy these 
organisms outside of the wound, or body, than in it, and 
in a proper appreciation of this fact lies confidence of 
perfect success. These conditions then demand the 
thorough preparation and sterilization of the surface of 
the patient, more especially in the vicinity of the site 
of the proposed operation; and not only a thorough 
sterilization of the epidermis itself but also of every- 
things absolutely everything^ which is in any way likely 



253 

to come in contact with the wound area. There should 
be, if possible, absolutely no avenue by means of which 
infection can reach such area. Chemical sterilization 
is still important— even indispensable in some fields of 
modern surgery; but as concomitant and valuable fac 
tors we also have certain mechanical measures of purifi- 
cation which form an essential part of aseptic prepara- 
tion properly so-called. No one link in the chain is to 
be overlooked. Demosthenes once said that there were 
three requisites for perfect oratory, namely, action, 
action and action. So also there are three essentials in 
perfect antisepsis, namely, thoroughness, thoroughness 
and THOROUGHNESS. The thickened epidermis about 
the wound edge is a favorite nidus for germs; they col- 
lect, and warmth and moisture aid in their subsequent 
development. Not only must the germ be thoroughly 
killed or excluded but the possibility or subsequent in- 
fection must also be forseen and guarded against. For 
instance, in even an ideal aseptic and antiseptic opera- 
tion in which there is much subsequent discharge or 
oozing there is danger of infection and subsequent de- 
composition of these discharges; they must, if possible, 
be absorbed and sterilized and for this purpose dry 
dressings are frequently valuable. As Gerster says: 
'*The dryer the operation the dryer the course of heal- 
ing" and also that "dry absorbent dressings, favoring 
rapid evaporation, are most useful in the treatment of 
extensive aseptic wounds." Indeed in an extensive cor- 
respondence with the leading surgeons of America, 
Great Britain, France and Germany I fiod the dry dress- 



254 

ing almost universally endorsed; the moist dressing be- 
ing used in infected areas and the dry dressing being 
almost exclusively used in aseptic operative procedures. 
Experiments upon animals, as we have previously 
shown, have demonstrated the fact that when micro- 
organisms were introduced into the circulation and any 
portion of the body was injured, that is where there 
was a local depression of vitality, that there developed 
a subsequent invasion of such injured tissues by the 
microorganisms — that is, there was a sort of inter- 
nal invasion. The virulence of such germs, or their 
capacity for virulent action, was modified in certain de- 
grees according to the length of time they remained in 
the circulation; their number and vitality being evi- 
dently lessened the longer they remained in contact 
with the blood— that is, within certain definite limits. 
For instance, this power of the blood is definite and 
limited and in the case of invasion by large numbers of 
germs would be exhausted before securing complete 
destruction of all the germs. In this latter case, when 
the blood has lost its germicidal power it becomes a good 
culture medium and the germ then thrives rather than 
dies. Yet if limited numbers of these self same micro- 
organisms be injected into perfectly healthy non injured 
animals not only is such injection followed by negative 
results but the destruction of the germs is prompt. 
This demonstrates then that certain tissues have a cer- 
tain amount of inherent germicidal power within cer- 
tain limits; also that the healthy organism is frequently 
able to Gope, unaided j with disease. But when the 



255 

health and the properties resultant thereon are dis- 
turbed or when the germ invades in large and over- 
whelming numbers it then becomes necessary to afford 
such aid as will reinforce these antagonistic properties 
which are peculiar to health. It is incumbent upon us 
to prevent infection, as far as is possible; this means 
that we should so protect the parts from contact with 
micro-organisms that their entrance within the systemic 
portals, or even their lingering at the gates as it were, 
would be an utter impossibility. If they once succeed 
in reaching the tissues, though every effort be made to 
destroy them lodged, as they are, in the vital strong- 
holds, it is possible that though partly devitalized they 
may ultimately renew their life with as much vigor and 
be fully as capable of harm as before. In order to 
overcome this possibility we must prevent their access 
— indeed, as Gerster says: "Prevention has become 
the watchword of modern practice, and it can be said 
that, by the successful employment of the preventive 
methods of the present day, surgery has become a con^ 
servative branch of the healing art." After the germ 
has once gained entrance, and a foothold, not only may 
it be diflScult either to dislodge it or kill it but in our 
zealous efforts in the latter direction we may even 
seriously impair the vital activity of the cellular con- 
stituents of the adjacent tissues, producing almost as 
much harm as the germ itself. The acme of success 
lies in preventing development — not in allowing it and 
then cutting it short subsequently, but in rendering it 
an utter impossibility. The acme of success lies in 
prevention. 



256 

In closing this brief and somewhat imperfect resume 
of the triumphs of antisepsis in the surgical art we can 
not refrain from quoting that magnificent apostrophe 
which Arpad Gerster has so eloquently uttered: 

"Having passed in review the present status of anti- 
parasitic surgery, we see that although incisive changes 
have befallen the means employed, the principles upon 
which the discipline was grounded remain unshaken. 
The living spark of truth has survived the pedantry 
and over-zeal of the advocates, as well as the sneers and 
contempt of the opponents of the new departure. Its 
blessings have soothed and removed untold suffering and 
misery — have saved I might say, millions of lives. For 
all this humanity is indebted to one man, whose intel- 
lect pierced the deadly mists that overhung the practice 
of surgery. That to the activity of the surgeon, though 
it still remains surrounded by grave responsibilities, 
was added a vastly increased element of pleasure, the 
gaudium certaminis against disease and death — for this 
gift to his fellow-surgeons we are indebted to Sir Joseph 
Lister." 



357 



X. — Their Value aisid Use in Obstetrics and 

Gynecology. 

The influence of antisepsis and asepsis was far-reach- 
ing. It pervaded wholly all of the various fields of 
medical science; it not only revolutionized surgery and 
left its decided impress upon the general practice of 
medicine but also very notably affected obstetrics and 
gynecology. No sooner had the benefits of Lister's 
teachings been fully demonstrated than obstetricians 
and gynecologists began the application of similar 
methods and principles in the lying-in chamber and op- 
erating room. This was done anxiously and expectant- 
ly at first but the ultimate fruit of success was the 
establishment of supreme confidence. In obstetrics, as 
well as in the other fields of the medical art, sepsis is 
the chief general condition dependent upon the presence 
of micro-organisms. The technical use of this term 
implies not only the actual presence of such micro or- 
ganisms but also the various accompanying forms of in- 
toxication which result from certain forms of necrobio- 
sis or destruction of the minuter and cellular elements 
of the tissues. It is not necessary to uphold this state- 
ment by lengthy argument, for it has been indubitably 
proven— indeed the occurrence of sepsis and septic con- 
ditions is now universally admitted to be due to the 
presence of certain and particular forms of germ life. 
Of the conservative and other various phenomena in- 
duced by their presence, suppuration is at once the most 



258 

common and most obvious. The commonest of the 
pyogenic or pus-forming germs are the Staphylococcus 
pyogenes aureus, albus and citrus and the Streptococcus 
pyogenes. 

These germs by their presence induce septic condi- 
tions, ergo^ prevent their access to and subsequent inva- 
sion of the tissues and the occurrence, development and 
consequences of sepsis, in its various forms, are also 
prevented. This also is universally ackoowledged. 
However much we may disagree in our opinions as to 
the use or virtue of any particular antiseptic substance 
we must and do all agree unanimously as to the extreme 
virtue of the principle. There is not the slightest doubt 
but that it is infinitely better for the parturient woman 
not only to render such patient absolutely clean, domes- 
tically, surgically and bacteriologically, but also to ex- 
clude all septic influences from the puerperal chamber. 
Of course ideal conditions in this respect are hardly 
possible to attain and it is infinitely easier to write this 
than to do this; but it is possible to attain a relative 
freedom from such infectious influences by the exercise 
of absolute care and patience — "patience is bitter but its 
fruit is sweet." It may cost the physician some incon- 
venience and trouble, but is the life and health of the 
patient to be bartered for the convenience of the pro- 
fessional attendant? 

The means by which disinfection is accomplished are 
legion. Probably the best means of sterilization of in- 
struments and dressings is by the use of the antiseptic 
and germicidal power of moist heat; this is readily at- 



269 

tained by the use of the Arnold and other forms of 
sterilizers which are now made for the use of the phy- 
sician and surgeon. Sterilization of instruments and 
dressings materially decreases the chances of infection 
as far as the armamentarium per se is concerned. But 
we must also be mindful of the fact that there are other 
avenues by means of which infection may gain access 
and these are of equal, if not greater, importance — 
namely, the patient's own body and the operator's 
hands, as has been shown in a previous paper. Kelly, 
Robb and Ghriskey, of the Johns Hopkins University, 
have proven by rigid and ample experimentation that 
the Staphylococcus pyogenes albus^ and sometimes aureus^ 
are present in enormous numbers on the hands and 
about the nails of all physicians and surgeons. This is 
but natural when we consider how often they come in 
contact with infectious material. The possibility of 
direct transmission of infection by the hands of the 
physician first seemed to suggest itself in the occur- 
rence of puerperal septicemia under conditions which 
seemed to indicate such a cause. Of this fact there are 
recorded many lamentable instances. This origin of 
the disease was pointed out by Gordon toward the lat- 
ter part of the last century; he said that he himself 
'^was the means of carrying the infection to a great 
number of women" and also traced the spread of the 
disease in the same way in the practice of certain mid- 
wives. As Playfair remarks, in some remarkable in- 
stances this unhappy property of carrying contagion 
has clung to individuals in a way that formerly seemed 



260 

most mysterious and led to the supposition that the 
whole system had become saturated, as it were, with 
some subtle and volatile poison. One of the strangest 
cases of this kind was that of Dr. Rutter, of Philadel- 
phia, which caused much discussion. He had forty five 
cases of puerperal septicemia in his own practice in one 
year, while none of his neighbors' patients were at- 
tacked. It is related that, in order to "rid himself of 
the mysterious influence which seemed to attend upon 
his practice, he left the city for ten days, and before 
waiting on the next parturient case had his hair shaved 
off and put on a wig, took a hot bath, and changed 
every particle of his apparel, taking nothing with him 
that he had worn or carried to his knowledge on any 
former occasion; and mark the result. The lady, not- 
withstanding that she had an easy parturition, was 
seized the next day with childbed fever, and died on 
the eleventh day after the birth of the child. Two 
years later he made another attempt at self-purification, 
and the next case attended fell a victim to the same 
disease." Meigs, in commenting on the case, refused to 
believe that Dr. Rutter carried the poison, but rather 
thought that he was ^^merely unhappy in meeting with 
such accidents through Ood '5 providence," and asks, 
"Did he distil a subtle essence which he carried with 
him?" It appears, however, that Dr. Rutter was the 
subject of a form of ozena which was sufficiently severe 
to disfigure him in time, from its effect upon the con- 
tour of his nose, as Harris says. It is, of course, obvi- 
ous that under these peculiar circumstances his hands 



261 

could never have been free from pyogenic organisms 
and septic matter. This is of peculiar interest because 
it shows how obscure may be the source of infection 
and how thorough must be the preparation which would 
obviate its transmission to a patient. This is only one 
of many, many thousands of similar cases— that is, 
similar in the fact that the infection was directly trans- 
mitted. 

Not only may contagion dwell within or upon the 
person of the physician, as in the case just cited, but 
Kelly, Robb, Ghriskey and others have proven that 
pyogenic organisms are to be found in quantity upon 
the hands and beneath the nails of every physician and 
surgeon — at least, this occurred in the case of every 
single one of a large number who were examined. Not 
only were these germs found in quantity but it was also 
demonstrated that washing and scrubbing the hands 
with brush, soap and water, even as long as twenty-five 
minutes, was utterly inadequate to remove all of the 
germs. Nevertheless such washing and scrubbing by 
mechanically removing detachable epithelial and sub- 
ungual debris which are constantly loaded with germs 
materially reduces the chances of infection. In sixty- 
five experiments upon physicians who scrubbed the 
hands freely, from ten to twenty five minutes, with 
strong brown soap and hot water frequently changed, 
fifty-six (that is, all but nine) yielded numerous colonies 
of pyogenic organisms; in almost every case these germs 
were specimens of Staphylococcus pyogenes albus and in 
some cases Staphylococcus pyogenes aureus. The remain- 



262 

iDg nine owed their escape to the inhibitory influence of 
mercuric chlorid which had been used as far back as the 
previous day. In seven additional experiments which 
were made upon nurses, positive results were obtained 
in every case, developing variously forty, sixty, six 
hundred and myriads of colonies of Staphylococcus pyo* 
genes albus and a few of aureus. As the experimenters 
remark, it was known in each instance that the test was 
about to be made and all endeavored by unusually vig- 
orous efforts to earn the credit of "no growtl." 

Kelly further remarks that solutions of corrosive 
sublimate (mercuric chlorid or bi chlorid of mercury) 
even as strong as 1:500 are /^^/ germicidal after immer- 
sion of the hands from two to five minutes. The mer- 
cury salt acts either by mechanically coating some por- 
tion of the coccus or else chemically combining with it, 
thus only inhibiting further growth until the salt is pre- 
cipitated or otherwise removed. Kelley says: "This I 
have repeatedly shown to be true following both the 
ordinary practice of immersion of the hands from two 
to five minutes in 1:500 and 1:1000 solutions after a pre- 
liminary washing for ten minutes with soap and water, 
and again after carefully following out Fuerbringer's 
method, now so generally adopted. The latter method 
was distinctly shown to be inefficient in almost every 
instance. It is briefly the following: 

Clean the nails with a pointed steel. 

Scrub the hands, especially the nails, one minute with 
soap and hot water and a sterile brush. 

Immerse the hands in alcohol (not under eight per 



263 

cent) for one minute; immediately transfer hands, still 
wet with the alcohol, to a freshly-prepared solution of 
mercury bi-chloride, 1:500, for one minute, when they are 
supposed to be sterile, 

I exhibit in my hands four tubes carrying cultures which 
failed to develop after sterilizing by this method, illu- 
sively showing an apparent sterility, for here on the 
other hand, are cultures taken from the same fingers 
after precipitating the bichloride with a sterile ammonium 
sulphide solution^ and these shorn innumerable coloniesP 

These results are striking and are but confirmed by 
the late experiments exploding the old classic belief in 
the inordinate germicidal power of mercuric chlorid, 
which has been heretofore placed so inexactly and so 
inaccurately high. He further says: *'It is a remarka- 
ble fact, of great practical importance, that this inhibi- 
tory effect of the bichloride holds over on the hands for 
twenty four hours. In two instances of men who had 
been away from the hospital for from four to six weeks, 
the ammonium sulphide produced the characteristic 
dark stain on the fingers, showing the presence of bichlo- 
ride. Here is the source of error explaining the nine 
negative results in the hands of my staff after simple 
soap-and-water cleansing. We did not then know of 
this property of the sublimate. 

Four experiments were made also with a four per 
cent solution of lysol; all yielded colonies. 

Three experiments with peroxide of hydrogen also 
furnished abundant colonies." From this we infer then 
that really positive results were obtained not only in 



264 

the case of the experiments upon the hands of nurses 
but also in the sixty-five experiments upon the hands of 
physicians; the nine apparent negative results being due 
to extraneous inhibition and not due to the scrubbing. 
We also conclude that mercuric chlorid, lysol (four per 
cent) and peroxide of hydrogen are useless as far as 
absolutely sterilizing the hands is concerned; the first, 
however, has strong inhibitory properties. Kelly favors 
the use of trimming and cleaning the nails, scrubbing 
the hands thoroughly with brown soap and hot water 
and subsequent immersion in a saturated solution of 
potassic permanganate followed by neutralization and 
decolorization by immersion in a saturated solution of 
oxalic acid; he claims that this thoroughly sterilizes the 
hands. Certainly such procedures are upheld by a large 
number of experiments in which no colonies developed 
subsequent to their use, even immediately after the 
demonstration of countless colonies after the use of 
soap and water. Also in the very low percentage of 
cases in which germs developed, in this latter case the 
occurrence of colonies being small and such as found 
consisting of small and definite numbers of micro or- 
ganisms. Potassic permanganate and oxalic acid are 
not only harmless to the hands but afford the most eftic- 
lent germicidal method of sterilizing the hands — in- 
deed, Kelly goes so far as to say^that soap and water 
and potassic permanganate and oxalic acid are the only 
true germicides for such use and therefore the best we 
have today. He further says that mercuric chlorid, al- 
though dangerous on wounds on account of its property 



265 

of coagulating and causing necrosis of albuminous tis- 
sues, has valuable properties of inhibiting, not destroying^ 
those germs with which it comes in contact. 

The physician must not only free himself from infec- 
tion but the patient and her attendants, as well as her 
surroundings, must also be kept absolutely clean. The 
physician should exercise due care and discretion in 
making vaginal examinations and after delivery should 
pay immediate attention to lesions of the genital tract. 
Antiseptic and aseptic precautions have so materially 
lowered the death rate from child-birth that it becomes 
incumbent upon every obstetrician to make use of those 
means and every precaution which guarantee increased 
safety, at least. The elementary principles involved in 
the practice of modern midwifery may be tersely, 
though not comprehensively summed up as follows: 

1. The patient must be made absolutely clean in all 
of her surroundings. The room, as well as the bed it- 
self, must be clean and free from infectious principles 
— that is, as far as is practicable. Cleanliness must be 
insisted upon; it is not expensive — fresh air and clean 
water cost but little. 

2.. The accoucheur must render himself as aseptic as 
possible; also all instruments or dressings which are to 
be used. The instruments and dressings may be steril- 
ized by moist heat; the hands by the liberal use of the 
brush, soap and water, the use of the nail brush and the 
subsequent use of some germicidal solution — preferably 
that of potassic permanganate and oxalic acid as has 
been previously described. The physician must make 
no examination until he is absolutely certain that he 



265 

can convey no infection to his patient thereby; indeed, 
he must avoid all examinations which are not absolutely 
necessary. 

3. The child must receive immediate attention when 
born, so that there may be no danger of sepsis— opthal- 
mic or otherwise. This precaution will not only en- 
tirely avert the occurrence of opthalmia neonatorum 
but of other infantile affections dependent upon the 
early occurrence of sepsis. 

A strict adherence to the dictates of such a policy, 
while not entirely eliminating death from obstetric 
practice will certainly materially decrease it. It may 
be argued that many cases thrive and progress to a 
favorable termination without the adoption of any pre- 
ventive measures whatever. This will readily be 
granted; but it cannot be denied that many more cases 
progress thus favorably under such precautions than 
without them. It is then the duty of the physician to 
spare himself no necessary precaution for the ultimate 
safety of the patient whose life and health is intrusted 
to his keepicg and when he accepts the issue he also 
accepts this responsibility. 

The benefits of antiseptic treatment in the various 
hospitals and lying in institutions have been so signal, 
so apparent, so enormous, that all criticism has been 
disarmed and silenced and every doubt as to value 
and expediency has vanished. This is happily true of 
hospitals, but a condition of things obtains in private 
practice which is not altogether to the credit of those 
who neglect proper precautions. Nearly twenty years 
ago ^the mortality in the various lying-in institutions 



267 

was so great that the International Congress of Physi- 
cians and Surgeons, then in session at Brussels, adopted 
resolutions asking for the abolition of such. The 
prevalence of puerperal septicemia in hospitals or insti- 
tutions in which lying-in women are coogrpgated had 
been constantly observed, both at home and abroad; 
this was accompanied in a vast majority of cases by a 
most appalling death rate. The disease when once de- 
veloped spread rapidly from one patient to another 
until infection was general in spite of all that could be 
done. In the years 1760, 1768 and 1770 the disease 
prevailed to such an extent in London that in some of 
the institutions nearly all of the patients died. It is 
stated of the Edinburgh Infirmary, in this connection, 
that in the year 1773 "almost every woman as soon as 
she was delivered, or perhaps about twenty-four hours 
after, was seized with it, and all of them died, though 
every method was used to cure the disorder." The 
lying-in institutions of the Continent were conducted 
upon a much larger scale but the death rate was equally 
large here, even in some of the very best of such insti- 
tutions. In the Maison d^Accouchements of Paris, during 
many different years, the death rate rose so high that 
one out of every three patients delivered died — on other 
occasions as many as ten out of fifteen women delivered 
died. These frightful results were not peculiar to any 
one institution nor to any one class of institutions — all 
seemed beneath the ban. In Vienna in 1823, 19 per 
cent of the cases died; in 1842, 16 per cent. This con- 
dition of affairs progressed until in Berlin in the year 
1862 hardly a single patient escaped death and the hos- 



268 

pital was therefore eventually closed. It was upon a 
basis of such fact that the action of the Brussels Con- 
gress was predicated. Now the conditions are entirely 
reversed, the mortality in private practice being greater 
than that of the hospitals, although by no means alarm- 
ing. The reason for this is obvious. In the hospital or 
lying-in institution every precaution is taken; not only 
are all instruments and dressings sterilized, as well as 
the hands of the operator, but the whole institution and 
its wards have been kept in as good a condition of asep- 
sis as is possible under the circumstances. The nurses 
are properly trained and instructed and a systematic 
and thorough preparation has been made for an earnest 
extermination of danger from septic causes. In the 
home of the patient all of these conditions, even fre- 
quently with the exercise of proper care, do not always 
obtain. The channels by which infection is subtly 
transmitted or brought within the portals are many and 
except in illness (and not always then) no systematic 
effort is made to exclude it. To reproduce the results 
attained in the hospital or to reproduce the conditions 
which surround the patient in the hospital we must 
practically reproduce the hospital itself— or at least its 
discipline. 

At the present day, as we have said, the mortality of 
private practice is greater than that of hospital practice. 
It is now between eleven and twelve years since anti- 
septic methods of treatment were introduced in the 
New York Maternity Hospital and the result there, as 
elsewhere, has been a uniform and enormous decrease 
in not only the occurrence of disease from septic causes 



269 



but in a most significant reduction of the mortality. 
Garrigues says that during the nine years preceding the 
introduction of such methods, (1875 to 1883), 3,504 
women were confined in the institution, 146 of whom 
died — that is, 4.17 per cent. During the last six 
months before the change was made, 237 women were 
delivered, 19 of whom died— that is, 8 per cent. Of 
these nineteen, seventeen succumbed to sepsis— that is 
7.17 per cent. During the last month before the intro- 
duction of antiseptic methods the total mortality reached 
20 per cent and that from sepsis or infection 15.69 per 
cent. The results following the use of antisepsis he 
tabulates as follows: 





< 

M 


DEATHS. 


PER CENT. 


Year. 


Total. 


From 

Sepsis 


Total 
Mortality. 


From Sepsis. 












1884 


532 


8 


4 


1.53 


0.76 


1885 


537 


3 





0.56 


0.00 


1886 


446 


5 


1 


].12 


0.23 


1887 


389 


5 


1 


1 80 


26 


18t8 


377 


3 





0.79 


0.00 


1889 


314 


1 





32 


00 


1890 


345 


4 


1 


1 13 


0.2? 


1891 


240 


1 





i2 


0.00 




3170 


30 


7 


0.90 


0.19 



270 

These figures are significant; they reveal the fact that 
during the years 1885, 1888, 1889 and 1891 there were 
absolutely no deaths from sepsis in this institution, and 
at no time in the years tabulated did the mortality from 
sepsis run above .76 per cent and in one-half of the 
time was .00 per cent! The mortality in the nine years 
preceding the introduction of antiseptic methods was 
nearly 500 per cent (5 times) greater than the same 
during the eight years following the introduction of 
such methods of treatment. The deaths from septic in- 
fection were reduced to one fifth of one per cent! Con- 
trast this condition with that of pre Listerian days. In 
the last six months of the non-antiseptic method in the 
New York Maternity Hospital the mortality from sep- 
tic causes was 7.17 per cent or more than 35 out of 500; 
this was reduced by antisepsis to less than 1 out of 500. 
These mortalities give startling comparisons but the re- 
sults from antiseptic methods are substantiated by 
Garrigues by the following statistics: 

The Sloane Maternity Hospital of New York was 
founded comparatively recently; in the report of the 
first thousand cases only six deaths were reported — only 
one of these from sepsis. This would give a general 
mortality of six-tenths of one per cent (0.6 per cent) and 
a mortality from septic causes of one-tenth of one per 
cent (0.1 per cent). 

Pippingskoeld of Helsingfors during the period of 
1884 to 1887, with an average of 650 deliveries per 
annum^ had a mortality of 0.29 per cent. 

Mermann of Manheim had nearly 700 cases before a 



271 

single death occurred, and that one was due to rupture 
of the uterus. 

Carl von Braun of Vienna in 1004 consecutive cases 
met with only two deaths. 

Obstetrics and gynecology owe a lasting debt to sur- 
gery for the benefits of improved surgical methods 
and the development of great skill in operative tech- 
nique as well. Indeed to the specialist in surgery are 
now relegated many of the operative procedures of both 
obstetrics and gynecology. Cesarian section, ovario- 
tomy, hysterectomy, laparotomy for tubal pregnancy 
and other causes, and other kindred measures are now 
properly surgical operations. For their successful ob- 
viation we are indebted largely to surgical progress and 
the application of the results to such forms of treatment. 
Indeed we find that the influence of modern surgery has 
largely modified many of the ordinary obstetrical gyne- 
cological procedures. 

By far the most formidable septic condition which 
confronts the obstetrician is puerperal septicemia. The 
condition is, or was rather, unhappily too common to 
need a description of its incubation, symptoms and the 
various phenomena which attend its course. The in- 
fluence which antiseptic measures have had upon its 
development has already been fully considered statisti- 
cally. Hermann gives the following etiological factors 
in the production of a puerperal infection: 

1. External infection, caused by pathogenic cocci. 
This can be prevented by subjective antisepsis. 

2. Auto-infection, as understood by Semmelweiss, 
which may be divided into. 



272 

{a) Ptomaine intoxication or putrid infection caused 
by micro-organisms. It cannot be combated and vaginal 
injections are useless. Prevention is the necessity. 

{i) Pathological germs which have been lying dor- 
mant and are brought into action by the birth. These 
we find in cases of old exudations, pyo- salpingitis and 
old abscesses of the glands of Bartholini. In these 
cases vaginal injections are also usually useless. ' 

3. Vaginal infection caused by pathogenic germs 
which have found their way into the vagina before labor 
began. 

In all of the branches of modern medicine the watch- 
word is prevention. This is probably the only method 
by which the development of all varieties of puerperal 
infection may be prevented. A perfectly ideal manage- 
ment of all puerperal cases may not be theoretically at- 
tained, although practically sufficient to prevent the de- 
velopment of dangerous or even other than the mildest 
symptoms. In very many lying-in institutions very 
rigid rules are laid down with a view to the prevention 
of the possibility of transmission of infectious material 
to the patient either on the hands of the attendants or 
on instruments, napkins, etc., and these have met with 
most satisfactory results. Until recently a few practi- 
tioners ridiculed the use of such precautions which were 
certainly strongly indicative of a proper recognition of 
the danger and also an earnest endeavor to remove it. 
Local antisepsis has accomplished most valuable and 
fruitful results \vhich are by no means to be underesti- 
mated. Many experiments and attempts have been 



273 

made to apply a system of antiseptic medication by the 
internal use of antiseptic substances but these have, as 
yet, been unfruitful. While local antisepsis has yielded 
brilliant results, the outlook in puerperal infection, as 
far as the virtues expected from internal administration 
of antiseptics are concerned, is certainly, as yet, not 
very bright. 



XL — The Essentials of Antisepsis and Asepsis. 

Thanks to the certain and infallible foundation af- 
forded modern surgery by the antiseptic method of 
wound treatment and to the subsequent uniform adhe- 
sion and healing of wounds when so treated, the tech- 
nique of operative surgery has received a most extra- 
ordinary and tremendous stimulus during the past 
quarter of a century. This was but natural for anti- 
sepsis and asepsis put within the hand of the surgeon a 
never failing aid and reared up for him an ever- reliable 
foundation of confidence; and apon this positive founda- 
tion it was the function of modern surgery to rear a 
superstructure of brilliant work and of still more bril- 
liant and indeed unparalleled results. With thorough 
and conscientious precautions, there is not at the pres- 
ent time any portion of the human body which is en- 
tirely without the pale of the dominion of the surgical 
sceptre — the scalpel. There is within the organism no 
veiled sanctum sanctorum to stay the hand of the sur- 
geon in a progression which erstwhile would have been 



274 

deemed profanation. The cranial cavity and its con- 
tents no longer constitute a noli me tangere. The tho- 
racic and abdominal cavities, and the joints as well, are 
invaded, under proper precautions, with absolutely no 
fear of evil consequences; they are now approached 
with a well-merited boldness of such a nature as would 
have stamped the effort in former times as the offspring 
of either madness or criminality. The only bugbears 
which can and do frighten the modern surgeon are his 
own personal technical sins, from which the avenging 
Nemesis should afford him no protection. Not only 
are these facts, and their proper appreciation, of the ut- 
most value in purely reparative work but they are also 
of equal importance in their bearing upon diagnosis of 
surgical and other affections. Formerly surgery was a 
dernier ressort; it was resorted to only when all other 
means of relief or reparation had failed and when the 
chances for future failures were in consequence but in- 
creased. Now, however, we may operate not only for 
relief but also for information, for purposes of diagno- 
sis, in order to lay a positive foundation upon which to 
build proper measures of relief, whether surgical or 
otherwise. Indeed it may well be said that at the 
present time the most radical surgery is pre eminently 
the most conservative in its results. These conditions 
necessarily and materially amplify the scope of opera- 
tive skill and technique; but they also entail a double 
duty — thorough antisepsis, or asepsis, and thorough 
technique down to the minutest details. 

Nevertheless the element of undoubted safety which 



275 

has been added to most operations has engendered 
some curious conditions. Clumsy and bungling opera- 
tors who, under former methods, had hitherto achieved 
but a slight modicum of success, now accomplished even 
brilliant results, simply through use of antisepsis, while 
in other cases operators of even marvelous .manual and 
technical dexterity signally failed, simply through lack 
of these proper precautions. Not that antisepsis and 
asepsis encouraged carelessness or that a premium was 
placed upon crudity— far from it! The brilliant, aston- 
ishing and classic triumphs of modern surgery were 
only possible by a combination of what Gerster fittingly 
terms "technical skill, the cunning of hand and brains, 
with the conscientious practice or a thorough-going 
cleanliness." The advantage then lay, not in the en- 
couragement of careless work but in the fact that even 
in spite of it the former technical bungler was given a 
chance of success despite his operative bungling, while 
the truly skilled were vouchsafed an attainment of re- 
sults which were hardly within the province of even 
their most sanguine expectations. Yet, on the other 
hand, this does not alter the fact that neglect of surgi- 
cal cleanliness invites a Nemesis whose retribution is 
not more swift than certain in its nature. It is none 
the less true, as has been said, that the barbaric neglect 
of cleanliness and lack of attention to hemorrhage, the 
rough methods, the tearing and the slashing frequently 
necessitated by lack of anesthesia in former days has 
now been preceded by more exact and cleahly modes of 
operating. Dissection is based upon proper technical 



276 

and anatomical knowledge, hemorrhage is controlled 
and the operative field thus kept dry, tissues are prop- 
erly retracted and the course of the knife made plain to 
the eye of the surgeon; cleancut incisions are made, if 
possible, which altogether materially increase or aid 
that natural and inherent tendency to repair. Indeed, 
with the ideal surgeon, his knowledge is as clean and 
sharp as his knife. 

Not only is it positively incumbent upon the surgeon 
to care for his patient, by proper surgical skill and tech- 
nique, during the operation to which he has been sub- 
jected, but it is also his duty to care for the conditions 
which surround that equally critical period, the stage of 
repair and recovery. Not only must the patient be 
properly protected against the injury and danger of 
wound infection during the course of an operation but 
just as thoroughly, just as effectively during convales- 
cence — the duty in this respect does not terminate un- 
til the condition and its consequences have either term- 
inated or else the relation of physician and patient be 
kept no longer intact. This means the institution of a 
rapid, progressive and undisturbed process of repair and 
healing of every operative wound — not by methods 
which are fantastic, not by means which are impossible, 
not by methods which are not accessible to every phy- 
sician and gurgeon, not by an enormous expenditure of 
time, money and worry, but by the simple exclusion of 
all possible means of infection. Experience has amply 
taught us that every wound, with proper care and atten- 
tion, may be caused to adhere and uniformly progress 



277 

to a state of consummated repair, provided that the ex- 
clusion of micro-organisms and their products from the 
affected tissues be secured. When we consider the 
protean forms in which the masked infection may assail 
favorable foci, it means naught else than the exercise 
of that eternal vigilance which is said to be the price of 
liberty. Unless destroyed or removed, microorganisms 
cling to all objects which come in contact with the 
wound — this is true of even the hand of the surgeon 
himself. Therefore the care and foresight of the opera- 
tor must not only be constant but also universal. Does 
this mean trouble? Does this mean expenditure of 
time? Yes, but it is economy of both. It does not re- 
quire the one-half of either which will be required upon 
the occurrence of septic developments later, due to the 
criminal carelessness and neglect of the surgeon who 
has culpably exposed the life or health of the patient 
who has trustingly placed both in his care. More often 
than not when such occurs, when sepsis develops, it is 
frequently too late to purchase life or health by the ex- 
penditure of any amount of either time or trouble. Nor 
can the proper expenditure of time and trouble in the 
early days of the case be compared to the mortification 
and remorse which arises and overwhelms when it final- 
ly dawns upon the professional attendant that his self- 
ish regard for his own comfort has been allowed to 
jeopardize, even sacrifice, the life of his patient. It is 
again but the old, old story of the stitch in time which 
saves nine — only in this case applied with ten-fold force. 
The question is now no longer a debatable one — it 



278 

stands firmly grounded upon an unassailable and unim- 
pregnable foundation of eternal and established truth, 
of such strength as scientific dogma has heretofore 
seldom witnessed. 

Slightly more than twenty five years ago Lister first 
demonstrated the importance of a proper consideration 
of atmospheric dust and the chance of consequent infec- 
tion of atmospheric origin. The possibility of this he 
clearly demonstrated, although we know at the present 
time that the danger of a more material infection from 
instruments, dressings, hands, nails, etc., is infinitely 
greater. Nevertheless it is always a matter of greater 
safety when an operation can be performed in a clean 
room with smooth walls, where the possibility of stir- 
ring up dust, in any manner, from floor, walls, ceiling, 
furniture or ornaments has been reduced to a minimum 
if not entirely removed. Based upon facts which were 
themselves firmly founded upon ample clinical experi- 
ence, and based upon Pasteur's masterly demonstration 
of the origin and nature of the causes of decomposition 
in general, Lister instituted a method, a systematic 
method, for the purpose of combating the operation of 
such causes in the living flesh of the hospital ward and 
sick-room. He first demonstrated that decomposition 
in wounds only supervenes upon contact with something 
introduced from without; that upon exclusion of all 
possible chance of infection from without no decompo- 
sition occurred. The splendid results which immediate- 
ly followed an appreciation of this fact, and their sub- 
stantiation by the results obtained by Volkmann, 



279 

Schede, Thiersch, Socin and others beside Lister him- 
self, led to more extended investigations, demonstra- 
tions and enunciations upon the part of the latter. Fol- 
lowing this came the demonstration by Lister that the 
causes of infection introduced from without were essen- 
tially organic in nature since they were destroyed by 
such measures as effected the destruction of organic 
matter in general. Finally he established the fact that 
such organic sources of infection introduced from with- 
out were capable of development and reproduction — 
that is, that they were endowed y,iih life — they were 
living organisms. 

Pasteur has demonstrated that certain germs in cer- 
tain media uniformly produce certain new compounds 
— in this manner he not only explained butyric fermen- 
tation but even gave a minute description of the germ 
which was its cause. Other investigators also were at 
work; Billroth made researches into the nature of the 
specific material of wound infection. By far the most 
important of these investigations were made toward the 
latter part of the seventh decade of the present century 
by Robert Koch. He extended the generalizations of 
Lister and Pasteur, determining that in wounds or even 
in their absence certain varieties of decomposition were 
only produced, as in the case of liquids contained with- 
in glass flasks, as a result of the presence of certain or- 
ganisms. And from this germ of truth developed and 
upon this important determination is founded the germ 
theory of disease — that among infectious diseases each 
distinct group of pathological conditions, which we 



280 

term a disease, is directly caused or promoted by the 
presence and action of a specific and peculiar micro or- 
ganism. 

After positive demonstration of this point it became 
self-evident that one of the most important points in 
the treatment of infectious diseases was the prevention 
or modification of the morbid processes by exclusion of 
all such micro-organisms, or else the institution of con- 
ditions unfavorable to their growth and proliferation. 
The first attempt in this direction, after the promulga- 
tion of the doctrines of antisepsis, was made by Lister 
himself. He attempted to prevent wound infection of 
atmospheric origin by the use of the spray, enveloping 
operator and patient within an atmosphere impregnated 
by vaporized solutions of carbolic acid, which was sup- 
posed to penetrate dust particles and infectious matter 
floating in the atmosphere and render it innocuous. It 
has been demonstrated, by Stimson among others, that 
it is not only unnecessary but that it is indeed impossi- 
ble to attain the object sought, at least by such means 
as the spray. It is even claimed that its use is posi- 
tively injurious when compared with the results given 
by improved methods, because it creates a more or less 
violent agitation of the dust particles, dragging them 
over the exposed wound surface in spite of the fact that 
the temporary and incomplete contact of such particles 
with the spray is utterly insufficient to destroy or arrest 
the development of any infectious germs associated with 
such dust particles. Therefore the employment of the 
spray if not actually dangerous is certainly useless to 



281 

say the least. It is but justice to Sir Joseph Lister to 
say that he has long since discarded its use himself and 
even condemns it now; nevertheless, although its appli- 
cation was faulty the principles upon which its use were 
predicated remain absolutely unchanged in every single 
essential detail. We now know that the chance of at- 
mospheric infection is no less positive in character, 
though not nearly so great as formerly imagined. Tyn 
dall has positively and beautifully demonstrated that 
air becomes freed from dust by allowing the heavy par- 
ticles to settle. He demonstrated that if a beam of sun- 
light is allowed to pass through an empty closed vessel 
its path is evidenced as a bright streak because of the 
reflection of light by the dust particles. But if the ves- 
sel is laid at rest for a time, negative results are attain- 
ed, the path of light disappears because the dust par 
tides which formerly reflected the light have sunk to the 
bottom and no longer float in the atmosphere of the 
vessel. Tyndall thus describes the experiment: 

"Build a little chamber, and provide it with a door, 
windows and window shutters; let an aperture be made 
in one of the shutters through which a sunbeam can 
pass; close the door and shutters so that no light shall 
enter save through this aperture. The track of the sun- 
beam is at first perfectly plain and vivid in the air of 
the room. If all disturbance of the air be avoided, the 
luminous track will become fainter and fainter, until at 
last it disappears absolutely, and no trace of the beam 
is to be seen. What rendered the beam visible at first? 
The floating dust of the air, which, when thus illumi- 



282 

nated and observed, is as palpable to the sense as dust 
or powder placed in the palm of the hand In the still 
air, the dust gradually sinks to the floor, or sticks to the 
walls and ceiling, until finally, by this self cleansing 
process, the air is entirely freed from mechanically sus- 
pended matter." 

By further experiment he also proved that a dustless 
atmosphere is always disassociated from infection of 
atmospheric origin, that ''in all these cases you find the 
dust invariably producing its crop of bacteria, while 
neither the dustless air nor the nutritive infusion, nor 
both together, are ever able to produce this crop, your 
conclusion is simply irresistible that the dust of the air 
contains the germ of the crop which has appeared in 
your infusion. I repeat that there is no inference of 
experimental science more certain than this one." 

These facts are made use of; dust particles are now 
removed by ventilation or by washing walls and furni- 
ture and finally allowing the remaining dust to settle, 
when it may be removed by flushing walls and floor 
with sterilized or antiseptic solutions. For this reason 
most operating rooms are now constructed of highly 
polished and impervious materials, such as marble, 
which admit ready removal of dust by such means. 
Kuemmel has shown that a dustless operating room can 
be obtained in a well appointed hospital and Neuber 
has shown that most excellent results can be obtained 
in operations under such conditions— even without the 
use of antiseptic solutions, provided the hands, instru- 
ments, dressings, etc , be thoroughly sterilized. But 



283 

such ideal surroundings cannot always be secured, in- 
deed it is almost impossible outside of the hospital with 
its special equipment for just such purposes. It is prac- 
tically impossible to escape dust in inhabited localities, 
no matter how cleanly the domicile — indeed, the gen- 
eral practitioner will have to do most of his surgical 
work; such as it is, in more or less dusty surroundings. 
Therefore we are forced to employ irrigation to remove 
the chance or opportunity for such accidental infection. 
Gerster says: "But even a constant and powerful 
stream of fluids will not be able to dislodge all the par- 
ticles of dust that may have settled down upon and in- 
sinuated themselves into the nooks and crevices of a 
wound. Hence it is desirable to employ a liquid that, 
aside from its non irritant quality, will have the prop- 
erty of extinguishing the noxious effects of those parti- 
cles of dust that can not be washed away by the irriga- 
tion, but remain imbedded in the tissues. This is 
chemical sterilization?^ 

While these things which confront us are conditions 
and not theories, yet, as we have previously stated, of 
vastly greater importance and of vastly greater fre- 
quency is that form of infection termed contact infec- 
tion. This may be caused in myriads of ways, by the 
mere contact of unsterilized objects of any kind, whether 
such be the instruments, the sponges, the dressings, 
pledgets, or the hands of nurse or assistant, or even of 
the operator himself. To guard against such form of 
infection not only must the wound or site of operation 
be as thoroughly sterilized as possible but all objects 



284 

brought into contact with the wound, or with objects 
which are to be brought into contact with the wound, 
must be thoroughly sterilized as well. Infection by all 
channels, whether direct or indirect, must be thoroughly 
excluded. Upon this point we lay greatest stress, for 
only in such manner can thorough antisepsis or asepsis 
be secured. It is a trite old adage, but one well worthy 
of repetition here, that '*What is worth doing at all is 
worth doing well." Of nothing is this so true as of 
antiseptic and aseptic procedures, because the sin of the 
surgeon becomes two-fold — the sin of omission of thor- 
ough sterilization develops directly into the sin of com- 
mission of infection. And woe to the unfortunate oper- 
ator in such a case — who will shrive him from his sin? 
Is he excusable for ignorance? Is he excusable for care- 
lessness? Granting these facts, are we not forced to 
face the issue? 

Such conditions as we have described do undoubtedly 
exist— do we possess a remedy? Is it within our power 
to efficiently and thoroughly sterilize or disinfect every- 
thing which is liable to come into contact with the 
wound? The reply of Kocher to this question could 
hardly be more emphatic: ''This question is to be an- 
swered unhesitatingly in the affirmative as regards 
pledgets, dressings, sutures and instruments, and a phy- 
sician is no longer permitted to sin against the demands 
of absolute sterilization of the objects named or to ex- 
cuse defects in the antiseptic treatment of wounds by 
untoward external conditions." 

By what means can we secure antisepsis and asepsis? 



285 

There is a large number of drugs possessing disinfect- 
ing power and with each moment the* list increases in- 
terminably. Foremost among all of these agents stands 
carbolic acid, the substance to which antisepsis owes its 
birth; ih^ protege of Lister, cast aside but only to be re- 
ceived back again with ten-fold welcome when a riper 
experience had but served to confirm his first views. 
SuflSce it to say that carbolic acid is used exclusively by 
Lister, Annandale and other eminent operators. Mer- 
curic chloride (corrosive sublimate)]was formerly held in 
high favor but the experiments of Geppert, Tavel, Vic- 
querat, Zimmerman, Kelly, Welch, Robb, Ghriskey, 
McClintock and others all uniformly demonstrate that 
the germicidal value of the medicament was much over- 
rated — indeed, it is now considered to possess little if 
any germicidal power, certainly less than that of car- 
bolic acid, although its inhibitory power is high. Many 
operators have abandoned its use for carbolic acid and 
from a voluminous correspondence with many of the 
most prominent surgeons of America, Germany, France, 
England and Austria, I learn that many who use the 
sublimate restrict it to cleansing the skin in the vicinity 
of a projected operation. 

The sterilizing agent j>ar excellence for instruments 
and dressings is heat. Satisfactory sterilization of 
gauze, ligature and instruments can be secured by ex- 
posure for comparatively short periods to moist heat at 
a temperature at or slightly above that of boiling water. 
At temperatures of 266*^ Fahrenheit, and above, all mi- 
cro-organisms and their spores present in permeable ob- 



286 

jects are absolutely destroyed in a very few minutes. 
At many of the surgical clinics in this country and in 
Europe the steam or hot water sterilizer has become one 
of the most important adjuncts to the armentarium of 
the surgeon. The best, simplest and most accessible 
substitute for steam is boiling water. It was David- 
sohn who taught us to sterilize instruments by boiling. It 
was he who demonstrated that even the boiling of in- 
struments for five minutes, in covered vessels charged 
with water, was followed, not once, not twice, but 
invariably by perfect sterilization of the objects so 
treated. This may be continued for a longer time if 
desired, indeed the longer the better, within certain 
limits. We may feel assuredly confident, however, 
that we are using properly sterilized instruments when 
they have been immersed for half an hour in boiling 
water; but the great drawback to such boiling, especially 
when prolonged, was that all steel instruments were in- 
variably rusted and ultimately ruined. To the ingenuity 
of Schimmelbusch we are indebted for an expedient 
which, though simplicity itself, effectually overcame all 
objection on this score. He suggested the use of a one 
per cent aqueous solution of sodic carbonate (*'soda") 
in place of water alone; this prevented the much-dreaded 
rusting. The advantages of such methods of steriliza- 
tion are immeasurable in many respects; probably one 
of the most important is the simplicity of the process, 
and the apparatus as well, to say nothing of the ease 
with which the latter may be obtained and the former 
applied almost anywhere. 



287 

It is interesting to note that Tavel has demonstrated 
that solutions of sodic chlorid (common salt) and of 
sodic carbonate (soda) require much less boiling for com- 
plete sterilization than simple water. Therefore the 
addition of soda to water, as suggested by Schimmel- 
busch, to prevent rusting of instruments, in the process 
of sterilization is not only beneficial in such respect but 
also actually hastens and perfects sterilization. Tavel 
has shown that a solution of O.'ZS per cent of salt and of 
0.25 per cent of calcined soda is absolutely sterile after 
fifteen minutes' boiling (killing various spores, among 
others those of the bacillus of anthrax and of the hay 
bacillus); this solution also keeps very well, only a few 
mould fungi developing at the end of an exposure of 
several weekp, it is claimed. Gauze compresses, pledgets 
and silk Tavel claims to have rendered absolutely sterile 
by boiling them half an hour in the solution. He fur- 
thermore demonstrated that such solution was unirri- 
tating to wounds and to the peritoneum and hence, in 
his opinion, formed an excellent non irritating and ab- 
solutely sterile solution, when so boiled, which seemed 
to be especially adapted for purposes of aseptic irriga- 
tion. 

Perhaps it might behoove us to give some con- 
sideration to a few of those points, purely technical in 
nature, by means of which success is attained — per aspera 
ad astra. 



288 

Cleansing op the Patient and Sterilization of the 
Wound Area and Vicinity. 

Many surgeons give, where practicable, one or more 
warm baths preceding the operation. In the early days 
of antisepsis Volkmann thought that shaving and scrub- 
bing of the skin in the neighborhood of the proposed 
operation should precede all other measures with a view 
to disinfection. There cannot be the slightest doubt, 
in fact time has but comfirmed his practice, that the 
powerful adjuvants of razor, soap, stiff brush and hot 
water are of the most desirable nature. We know that 
masses of filth, cutaneous debris and of pathogenic and 
pyogenic micro-organisms cling to the epidermis and 
especially in those regions most covered with hair; fur 
thermore, such collections are permeated by the natural 
sebaceous secretions of the cutaneous glands, such coat- 
ing forming an effectual barrier against the penetration 
of watery solutions of antiseptic medicaments, with 
the probable exception of carbolic acid. Schimmel- 
buseh has demonstrated^the inhibitory effect of such 
unctuous materials upon the action of chemical sterili- 
zers in aqueous media. Therefore some means must be 
used for the removal of such objectionable substances. 
To effect this the area is shaved, if hairy, removing at 
once mechanically a great number of organisms as well 
as conditions favoring re -infection. Then thorough 
scrubbing with potash or soft soap, hot water and a stiff 
bristle brush sweeps away with rapidity and facility, 
grease, filth, cutaneous debris and noxious micro-organ- 



289 

ism^, leaving for the action of subsequently applied an- 
tiseptics but a minimum amount of work to do. 

Not only must we sterilize the wound area in the 
manner just indicated but it is obligatory that we look 
strenuously to the means by which we accomplish our 
objects. Among the various articles used for such pur- 
pose probably none is so exposed to infection and is 
therefore so liable to become a dangerous though un- 
conscious focus of infection as the surgical nail brush. 
Schimmelbusch has made extended investigations and 
experiments in the cleansing and sterilization of such 
brushes. He has positively shown that the common 
method of a single brief immersion, in even a strong 
germicidal solution, is hardly more than merely per 
functory in nature, it is entirely inadequate to destroy 
the adherent pathogenic and especially the pyogenic 
microorganisms and, moreover, inspires a confidence 
which is entirely fal^^e and which can be naught^^else 
than baneful in effect. Upon examining*the brushes so 
treated in the Berlin clinic Schimmelbusch found them 
to be especially rich in pyogenic bacteria; he also de- 
mostrated that an immersion of at least ten minutes 
duration and made in a strong mercuric solution was 
absolutely necessary. This was true when*the"^brushe8 
so sterilized were entirely free from the soap used in 
scrubbing. But more frequently than not the brushes 
are thrown back after use, fairly reeking with soapsuds 
aud infectious material, the soap rendering the subli- 
mate entirely4nert]^and^the*infectiousImaterial convert- 
ing what should be a haven of safety into a masked and 



290 

uncertain, and therefore doubly dangerous focus of in- 
fection. Therefore where sublimate sterilization of 
brushes is employed it is imperative that all soap should 
be cleansed from them before immersion in the subli- 
mate solution, otherwise perfect sterilization cannot be 
effected. On this account it is a source of great gratifi- 
cation and congratulation to learn from the researches 
of Schimmelbusch that simpler and far more reliable 
means of sterilization are within the reach of every 
physician and surgeon. He has proven that the most 
unclean brush can be rendered absolutely and indubit- 
ably aseptic by simple boiling for five minutes in a one 
per cent aqueous solution of soda. 

With such simple, effective and accessible means for 
the sterilization of surgical nail brushes at our disposal 
there cannot be the slightest shadow of an excuse for 
neglect in this direction, nor indeed can there be for 
culpable neglect anywhere in the chain of antiseptic or 
aseptic procedures essential to every precise and scien- 
tific operation. 

Cleansing and Steriltzation of Instruments. 

No one can doubt for an instant that the removal of 
such debris as pus, blood, portions of animal fibres and 
tissues and what not which inevitably cling to all in- 
struments used in the course of an operation, should be 
thoroughly attained before use of such instruments for 
operative work again. We do not think that even the 
most conservative adherents of the old fashioned meth- 
ods could or would gainsay the fact that such precaution 



291 

is only proper and legitimate — nay, even demanded. 
But what of the instrument which has come in contact 
with infected tissues, instruments which have bathed 
and reeked in the morbid discharges or tissues over- 
whelmed by erysipelas, by tuberculosis, by syphilis or 
by an infectious affection of any nature? Is the neces- 
sity for purification of these instruments not greater, 
incalculably greater, than in the case of instruments 
which have traversed only perfectly normal and unin- 
fected tissues? However, it has been demonstrated by 
Schiramelbusch that even the most careful, thorough 
and extensive scrubbing and washing of instruments 
with hot water, soap and a stiff brush does not and can 
not render them aseptic if they have been once infected. 
To many, especially artery forceps and other purposely 
roughened instruments, considerable and dangerous 
quantities of harmful germs were found adherent. It 
is necessary to do more than merely wash the instru- 
ments, no matter how thoroughly the latter process is 
conducted. Simplicity in an instrument is now, all 
other things being equal, the most desirable quality. 
The very best and certainly the very safest are the sim- 
plest, those fashioned entirely of one piece of metal and 
having no crevices and interstices to offer favorable 
lurking places for infectious material. They should, 
moreover, possess smooth and well-polished surfaces — 
no grooved or otherwise roughened handles; they are 
unnecessary, they are hard to clean thoroughly and 
what is more they directly invite and favor collection 
of infectious material and hence increase chances of 



292 

septic infection in operative work. As Gerster says: 
"Another factor has to be considered. In the large 
practice of our hospitals, where from three to five oper- 
ations are performed at one session, the minute cleans- 
ing of a large instrumentarium after each operation is 
tedious, involving considerable time. We either had 
to submit to this, or had to provide a disproportionately 
large and costly set of duplicates and triplicates. As a 
matter of fact, the latter thing was rarely resorted to, 
and the cleansing of the bloody instruments being hur- 
riedly and often inadequately done, main reliance was 
placed upon the disinfecting power of our carbolic acid 
bath. And as consideration for the assistants' hands 
had gradually caused the abandonment of the stronger 
for weaker solutions, frequent failures in securing 
primary union were the result of these evasive attempts." 

How different and how much more certain are the 
conditions at our disposal at the present time! All that 
we need is a covered vessel containing a one per cent 
aqueous solution of &oda; after boiling the instruments 
therein for five minutes we may empty them into steril- 
ized water or, better, a 1:20 or 1:30 solution of carbolic 
acid. They are thoroughly sterilized and are ready for 
use. In many hospitals cold sterilized soda solution is 
kept at hand to be poured over the hot instruments upon 
placing them into the tray. Sterilized water is also 
frequently employed for the same purpose. 

We may then sum up the requisites for thorough 
sterilization of instruments to be used in operative work 
as follows: 



293 

a. A thorough preliminary cleansing with a stiff 
brush and plenty of soap and hot water. 

b. After such preliminary cleansing all instruments 
are to be boiled for at least five minutes in a covered 
vessel containing a one per cent aqueous solution of 
soda. All instruments, complex in nature, which for 
any reason cannot be subjected to thorough preliminary 
cleaning, or which have been exposed to specially viru- 
lent infection, should for caution's sake^be boiled for 
haU an hour. 

c. After such sterilization is completed the instru- 
ments should be placed in a tray of three or four per 
cent carbolic acid solution to guard against infection 
before use. 

Note. — All instruments dropped during an operation 
should be left untouched unless re-sterilized. 

Preparation and Sterilization of Dressings. 

The dry preservation of dressing materials sterilized 
and impregnated with phenol or sublimate must be en- 
tirely rejected. Not that these substances possess no 
value but that such sterilization is but ephemeral at best 
in the case of dressings which are not used within a 
reasonably short time after subjecting them to such 
means of sterilizition. Phenol is more or less volatile 
and sublimate is rendered inert by long continued con- 
tact with organic matter. Sterilization can only exist 
as long as these agents are present in active form. 
Kocher says that positive demonstrations show that 
such is not the case with dry dressings chemically 



294 

sterilized, unless the materials are applied directly to 
the wound from the antiseptic solution. We cannot be 
sure that such dressings have not become re-infected 
after the antiseptic agent has volatilized or become 
inert. 

When we consider the large quantities of fabrics 
handled by the large number of persons required by 
the folding, immersing, wringing, unfolding, drying, 
refolding, cutting and final storing or preparation for 
shipment; when we also consider the fact that the work- 
men are necessarily devoid of the technical knowledge 
of asepsis and the minutse of conditions required by the 
surgeon in aseptic work, we must be forcibly struck by 
the chance of possible accidental contamination. Neces- 
sarily the manufacturer's standard is one more or less 
commercial in nature, the essential requisite to him is 
profit and yet he must also meet competition; therefore 
the work must be conducted by individuals to whom 
the requirements of surgical accuracy are matters of 
utter indifference, if indeed they be not also matters of 
utter ignorance. It is obligatory, it is essential that we 
assure ourselves beyond a peradventure that all dress 
ings are actually sterilized before employment in wound 
dressing. We surely cannot credit such an ideal to all 
dry dressings supplied by manufacturers. Not that 
their use should be forbidden but that they should not 
be accepted as sterilized when such evidence is based 
solely upon the ipse dixit of the manufacturer; he is 
surely not going to make derogatory remarks about his 
own products, and even where he is thoroughly consci- 



295 

entious the chances of infection, both while in his hands 
and afterwards, are utterly beyond his ken. Therefore 
if we do employ such dressing materials we should 
make assurance doubly sure by re sterilization. No 
better directions for such process can be given than 
those offered by Dr. Uerster in a recent paper on 
** Aseptic and Antiseptic Details in Operative Surgery;" 
we quote him verbatim: 

"For purposes where a reliable dressing has to be 
procured, extempore boiling in a soda or potash solution 
of about 1^ per cent for ten minutes is incomparably 
the simplest and most practical manner of getting an 
absorbent and aseptic material. In. this procedure we 
recognize at once the familiar ways of the laundry, the 
eminently aseptic results of which have been demon- 
strated beyond any reasonable doubt by Behring in the 
Berlin Hygienic Institute. Thus cotton or linen stuff, 
to be found in every household, can be readily rendered 
serviceable for surgical purposes by a short boiling in 
soda or potash lye. Well wrung out, it can be immedi- 
ately used, and will dry rapidly in situ under the influ- 
ence of the body heat and exposure to the air." 

Sterilization by means of hot air has also been sug- 
gested and employed but, as Gerster says, has not re- 
ceived consideration because of the necessity of costly 
and complicated apparatus. Then, also, there can be no 
question but that the methods of sterilization by em- 
ployment of moist heat are vastly more efficacious and 
vastly more simple than those by dry heat. These ob- 
jections, therefore, do not obtain against the employ- 



296 

ment of steam for purposes of disinfection or steriliza- 
tion. 

Preparation and Sterilization of Ligatures and 

Sutures. 

It must be obvious that infection of wounds may hap- 
pen through the medium of improperly prepared liga- 
tures and sutures, or where incompletely sterilized or 
even non-sterilized gauzes or other bibulous or porous 
materials are introduced into wound areas— even though 
for the purpose of absorption of discharges and conse- 
quent local drainage. Suppose, for example, that infec* 
tious material has been introduced by means of a suture; 
we have then transplanted into the wound an absolute 
and positive focus of incubation, proliferation and in- 
fection. The microorganisms find in the injured tis- 
sues, altered secretions and morbid discharges highly 
appropriate media for development. We have here 
conditions most favorable for a progressive, lasting and 
spreading infection. 

For such purposes as ligation and suturing, silk, cat- 
gut and silkworm gut are the materials most frequently 
employed. Well prepared catgut of suitable sizes may, 
at limes, be used for both. Probably one of the best 
methods for effectively and conveniently sterilizing cat- 
gut is that recommended by Kocher: 

Wash the commercial article in ether and then im- 
merse it for twenty-four hours in good oil of juniper 
berry; it may then be transferred and kept ready for use 
in a 1:1000 solution of sublimate, the medium of solu- 



297 

tion being absolute alcohol. The absolute alcohol, of 
course, hardens the catgut, making it firm but flexible. 
When it is desirable to prevent a too ready absorption 
the article may be especially hardened, after steriliza- 
tion and subsequent washing in alcohol, by immersion 
in a 1:20 solution of carbolic acid containing thirty 
grains of potassic di-chromate to the quart. An immer- 
sion of forty-eight hours duration will cause the sub- 
stance to resist absorption for a week or ten days. 

Silk may be boiled, as Czerny, of Heidelberg, directs, 
in a 1:20 carbolic acid solution for one hour, or else im- 
mersed for twenty-four hours in a solution of corrosive 
sublimate in alcohol (1:100) and then kept for subse- 
quent use in absolute alcohol. 

Silkworm-gut is easily threaded and moreover makes 
an excellent suture material. It may be prepared in the 
same manner as silk. A preliminary soaking, before 
use, in carbolic acid solution is said to render it more 
pliant and supple. 

Ligature materials, after chemical sterilization, should 
be wound upon spools of glass or other easily sterilized 
material and preserved by immersion in antiseptic solu- 
tion from which, when desired for use, they should be 
directly transferred to the wound. This latter proced- 
ure is allowable because the amount of adhering phenol 
or sublimate is small and of no importance as far as fear 
of toxic effects may be concerned; indeed the practice 
so far from being reprehensible is probably of decided 
advantage in that it effectually eliminates the chance 
of accidental infection at the time of its employment. 



298 

In the Billroth Clinic in Vienna, the silk is preserved 
in closed vessels in five per cent aqueous solution of 
carbolic acid; the silver wire in carbolic glycerin of ten 
per cent strength; the catgut in sublimate alcohol of one 
per cent strength; all are put into a two and a half per 
cent carbolic acid solution before use and are handed 
out of this. In order to make sure of avoiding any in- 
terchange, the instruments which are used in phlegmon, 
etc., are kept in a special wooden box by themselves 
and are conspicuously differentiated from the rest by 
means of their handles. 

Preparation akd Sterilization of Sponges. 

These articles, in many quarters, have been supplanted 
by pads or compresses of absorbent cotton or gauze, be- 
cause of the cheapness and comparatively easier 
methods of disinfection of the latter. Indeed many op- 
erators of distinction have altogether abandoned the use 
of marine sponges. Dr. W. W. Keen writes me thus: 
"I have practically abandoned marine sponges, and use 
sponges made of dry bichloride or sterilized gauze, 
rolled into balls about the ordinary size." In the clinic 
of Billroth in Vienna the use of sponges in laparotomy 
was discarded in 1887; at the present time sponges have 
been almost entirely supplanted, even in other opera- 
tions, by sterilized gauze compresses of various sizes. 
Gerster also says: 

"The large flat sponges so generally used in laparoto- 
my have been abandoned by me for three years as ex- 
pensive, and not as handy as small, well- sterilized com- 



299 

presses of plain, absorbent gauze, which, to prevent un- 
folding and fraying, are firmly tied with silk at one end. 
The surgeon is nowhere so cramped for lack of space 
as at his operations in the bottom of the pelvis. A 
sponge used for packing away intestines needs constant 
pressure to prevent its expansion and encroachment up- 
on available space. A pad of gauze held down for a 
short while will become packed, and will retain its 
shape and position even if released from digital pres- 
sure." 

Nevertheless for some purposes sponges, properly 
prepared, are peculiarly adapted and, as they are used 
by some surgeons yet, it may not be out of place to give 
some space to their consideration. Among other meas- 
ures which have been suggested is boiling; such a 
method is foolish in the extreme, because the process of 
sterilization by boiling robs the sponge entirely of those 
very properties which render it valuable, materially im- 
pairing its absorptive powers, its softness and its elas- 
ticity. 

Many operators bleach their sponges before using 
them, this is not essential but adds to the appearance. 
A good and reliable method of preparing and sterilizing 
sponges is as follows: 

a. Free the sponge from calcareous materials by dry 
beating and then immerse for about fifteen minutes in 
dilute hydrochloric acid. Then wash in cold water un- 
til all traces of the acid have been removed. 

b. After removal of calcareous matter, as directed, 
allow the sponges to stand a couple of days in water. 



300 

This will allow proliferation or germination of spores 
— the fully developed microbe being much more sus- 
ceptible to chemical sterilization than the spore. After 
such standing the sponge is more thoroughly and effect- 
ually sterilized. 

c. Thoroughly knead the sponge by hand with green 
soap and plenty of hot water for several minutes. 
Rinse away completely all traces of soap. 

d. Immerse in a five per cent solution of carbolic 
acid. An immersion of twenty-four hours, after such 
treatment as has been described, is said to render 
sponges absolutely sterile. 

After squeezing the sponges until free from excess of 
sterilizing solution, they may be preserved in steril- 
ized air-tight jars until needed for use. Before using 
they should be immersed for awhile in a five per cent 
solution of carbolic acid. 

Sponges once used may be re-sterilized by the same 
process; in case of saturation with blood they should be 
well washed in tepid water until all traces of blood have 
been removed. 

Sublimate should never be used for sterilization of 
sponges— contact renders it inert, especially in the 
presence of light and heat. 

As a rule sponges are only used in operations requir- 
ing rapid absorption of blood or secretion and more 
especially'iin tho8e|cases^where total arrest of hemorrhage 
is only possible by rapid completion of the operation. 
They are especially of service, fastened to sponge or 
artery forceps, in certain operations about the face, the 



301 

vagina, etc. They are also of great service in the rapid 
cleansing and preliminary tamponade of the intestinal 
canal in abdominal work. 

PREPARA.TI0N AND STERILIZATION OF THE HaNDS. 

Of equal importance for the attainment of success is 
sterilization of the hands of the operator, his assistants 
and his nurses. Kuemmel and Fuerbringer have both 
shown that enormous quantities of pathogenic and pyo- 
genic organisms are constantly lodged upon the hands 
and especially beneath the finger nails of even the clean- 
est of individuals, — this is particularly true of physi- 
cians and surgeons, as well as of all others directly ex- 
posed to infectious materials. No amount of washing, 
or scraping, or trimming of nails can absolutely remove 
these germs, more especially those lodged beneath the 
nails. To facilitate digital examination the finger is 
frequently lubricated with some oleaginous substance; 
this collects in the space beneath the nail, so also do the 
variou3 germs with which the examining finger neces- 
sarily comes in contact; they are finally crowded into 
and stored away in the space beneath the nail, firmly 
ensconced in the greasy collection and thereby effect- 
ually protected against penetration and action of anti- 
septic solutions. Therefore certain preliminary meas- 
ures of cleaning are necessary, as in the case of the 
sterilization of the skin of the patient in the vicinity of 
the wound. 

The hands, forearms and nails of operator, assistants 
and nurses should be thoroughly washed and scrubbed 



802 

in soap and hot water with a stiff bristle brush for five 
or ten minutes. The nails should then be trimmed and 
scraped, especially in the subungual space, and re- 
scrubbed. Kuemmel recommends green or potash soap 
for this purpose; this is an excellent suggestion as to 
the detergent action of the soap is added the antiseptic 
action of the usual excess of alkali in such soaps. 

For the sake of safety it is better that an operator, or 
his assistants, should not wear rings during an opera- 
tion; they should be taken off before the hands are 
scrubbed and remain off until the operation is entirely 
completed. It would also be wise to caution nurses, as 
Gerster suggests, against the wearirg of bangles, rings 
or bracelets. One thing should be thoroughly impressed 
upon all assistants and nurses — whenever a non-steril- 
ized object of any kind is touchad, no matter what its 
nature, it is imperative that the hands be sterilized 
anew. 

But as to the method of sterilization. Thanks to the 
use of steam and boiling water we have attained abso 
lute security in the disinfection of inanimate objects. 
Unfortunately, however, such absolute precision has not 
been attained in the sterilization of the hands, of the 
skin of the patient or of his tissues — nevertheless such 
is a necessity in the antiseptic and aseptic methods of 
wound treatment. We cannot hold our hands in the 
streaming stream, nor can we immerse them for five 
minutes in the boiling soda solution and certainly we 
cannot subject our patient to such measures. Hence for 
the preparation of hands and skin we are forced to the 



303 

adoption of a combination of mechanical and chemical 
sterilization. Bacteriological examinations by Tavel 
and Vicquerat show that the hands are usually rendered 
sterile by the method suggested by Fuerbringer. But 
this is by no means always reliable notwithstanding the 
great degree of confidence which it enjoys^ for if the 
operator has been exposed to infection (a condition in 
which sterilization of the hands becomes more impera- 
tive than ever), the method does not succeed in effect- 
ing sterilization. In order to test this Kocher opened 
a large abscess and purposely soiled himself with the 
discharges. In spite of thorough application of the 
method of Fuerbringer, colonies of staphylococci subse- 
quently developed. Kelly at Johns Hopkins University 
and Welch of the same institution have both proven 
that the method is unreliable— and especially in those 
cases when its use would be most desirable. They have 
given a great deal of attention to this subject and have 
suggested a more exact and certain method of manual 
sterilization which was fully discussed in a previous 
paper. For the details of this most recent and most 
successful method of sterilization of the hands see the 
paper "Antisepsis in Obstetrics." 

Irrigation. 

Upon this subject of irrigation a war of words has 
been waged /;'i? and con. Nevertheless it is too import- 
ant to be dismissed without some adequate notice, — by 
some it has been damned while by others it has been 
canonized. 



304 

All operative work is preceded by certain essential 
and preliminary measureSj such as the securing of a 
dustless atmosphere, thorough cleansing of the skin of 
the patient and of the hands of operator, assistants and 
nurses, thorough sterilization of instruments, sponges, 
dressings, etc. Were these preliminary measures al- 
ways uniformly and ideally successful then irrigation 
would be unnecessary. Unfortunately this is not alto- 
gether so, but as we progress towards the attainment of 
that ideal state the need of irrigation becomes more and 
more restricted. But as long as there is a chance for a 
flaw, as long as there is even ground for suspicion, just 
so long is irrigation an absolute necessity. 

It is usually impossible to secure a perfectly dustless 
atmosphere for operative work; therefore in order to re- 
move infectious material, whether from air or morbid 
substances derived from the organism itself, irrigation 
is usually employed. Moreover we must not forget the 
chances of accidental infection by inattention, they can 
hardly be excluded but are to a certain extent antici- 
pated or guarded against by irrigation. Indeed in many 
instances irrigation is most valuable, bridging over what 
would be culpable gaps hi an otherwise complete and 
faultless procedure. Suffice it to say that in regions 
which can be rendered aseptic with difficulty it is an in- 
dispensable adjunct to the surgeon. 

Irrigation may be either aseptic or antiseptic in na- 
ture — aseptic when simple, bland, sterilized solutions 
are employed; antiseptic when the irrigating fluids are 
vehicles of antiseptic or germicidal agents. The vir- 



805 

taes of irrigation may therefore be ascribed to either a 
chemical action or the mere mechanical cleansing effect 
of the stream injected against or over the tissues — or 
may be ascribed to a combination of both. It is inter- 
esting in this connection to note the experiments of 
Zimmerman and Tavel. In their experiments small 
pieces of meat were infected with definite micro«organ- 
isms; it was subsequently found that attempts at steril- 
ization of such infected particles were by no means 
always successful, even though the fragments of meat 
were immersed in a 0.1 per cent acid sublimate solution 
from one to five minutes. On the other hand, steriliza- 
tion was easily effected under the same conditions when 
infected strips of blotting paper were used in place of 
the fragments of meat. If then this contact of the 
strong antiseptic solution was insufficient to effect 
sterilization we can hardly hope to secure better results 
from the momentary contact in the case of wound irri- 
gation. In practical work micro- organisms are not 
usually found in surroundings which are ideal as far as 
the application of antiseptic principles is concerned. 
We do not find them disassociated from organic mate- 
rial. As Gerster says, they are not met with in the 
shape of thin, watery emulsions but are found imbedded 
in dense masses of what Lister appropriately called 
"lumps of dirt," in conglomerations of grease and epi- 
dermis, in powerful plugs of sticky slime, pus and blood 
clot. Therefore let us first emphasize the paramount 
antiseptic value of the homely methods employed for 
cleansing dirty surfaces, comprised in the term mechani- 



303 

cal purification; and secondly point out how infinitely 
more they aocomplish than any form of chemical disin- 
fection by watery germicidal solutions alone* Both 
should be combined. Still, as Kocher points out, Zim- 
merman obtained quite an important difference in de- 
gree by his disinfection, since a lesser number of colon- 
ies developed and these did so more slowly and at a 
later time, their virulence having been weakened. 
Therefore Lister, considering every wound to be theo- 
retically more or less infected, washed it with 0.2 per 
cent sublimate solution at the end of an operation; he 
has lately, however, discarded all other antiseptics in 
favor of carbolic acid. Many surgeons modify this 
process of antiseptic irrigation by final flushing of the 
wound area with a O.Vo per cent sterilized salt solution 
in order to wash away all trace of the antiseptic. 

Irrigation is now rarely employed in aseptic wounds, 
it is not only unnecessary but may even prove, as has 
been declared in some instances, actually harmful; it is 
therefore to be restricted to conditions or wounds which 
are not in a thoroughly aseptic condition, such as those 
in the neighborhood of the orifices of the body or in the 
vicinity of accidentally infected or actually suppurating 
areas. Gerster says: *'^ notable exception to this rule 
is the abdominal cavity^ wherein irrigation is never to be 
employed. This statement seems to condemn a widely 
spread practice, and some courage is needed to express 
it unreservedly. ^ * * How entirely useless, nay, 
pernicious, the effects of flushing the peritoneum are in 
cases of active septic infection, as, for instance, in the 



307 

presence of fetid feeal ab^^ce^ses due to intestinal per- 
foration, has been abundantly demonstrated to myself 
and to other surgeons here and abroad by numerous un- 
successful attempts. And there is nothing more certain 
than that, on account of its complex character, the peri- 
toneal cavity cannot be completely washed clean; that 
germicidal solutions cannot be used in a sufficient 
strength to be effective, and that finally an inert or weak 
solution will only help to spread the elements of infec- 
tion to previously unaffected areas. The substance of 
these assertions was essentially confirmed by experi- 
mental research on animals." 

As to opening large cavities of the body, it seems 
that no proof has been as yet offered that successful re- 
sults cannot be attained by the employment of proper 
precautions both before and after an operation, even 
though antiseptic irrigation be discarded. Indeed it 
may well be said, as has been done, that most opera- 
tions within the peritoneal cavity afford no very rigid 
test of the absolute value of the aseptic or antiseptic 
measures therein employed. The condition of the 
serous membranes and cavities, especially when exposed 
to infection through various channels, is by no means a 
proper and infallable guide for other injured tissues 
under the same conditions, such for example as muscu- 
lar or areolar tissue. The tolerance of the peritoneum 
is well known and seems almost incredible; therefore 
technical faults committed during abdominal operations 
are much oftener undetected and unpunished by septic 
developments than is the case in those similarly in- 



308 

curred in extra-peritoneal operations. Because of this, 
Kocher and many other surgeons now restrict them- 
selves, in abdominal operations, to antiseptic precautions 
before and after the operation rather than during its 
course, and discard antiseptic irrigation trusting the 
care of the wound during the operation to asepsis and 
to the inherent resistive power of normal tissue. 
Numerous experiments seem to demonstrate that the 
serous membranes are remarkably tolerant of infectious 
materials or else digest them with relative facility, 
thereby rendering them harmless, perhaps, as has been 
suggested, by the assistance of serous transudation. 
But this remarkable tolerance, as has been shown by 
Walthard and Tavel, exists only so long as the endothel- 
ium remains intact. The injured tissues encountered in a 
traumatism are by no means in this favorable condition; 
therefore the tolerance of the peritoneum should never 
be allowed the function of a cover beneath which to 
hide imperfect, careless and slipshod work. In lapa- 
rotomy as well as elsewhere — indeed if not more so — the 
employment of thorough, rigid and conscientious anti 
sepsis and asepsis is obligatory, it is naught else than a 
duty. As has been said, once overstep the limit of 
peritoneal tolerance and the danger usually becomes 
irretrievable — the life of the patient usually terminat- 
ing by a septic peritonitis for which there is no redress. 

Drainage. 

Many of the remarks made as to irrigation apply with 
equal force to drainage of wounds. As Qerster most 



309 

tersely says: "Imperfect cleanliness, copious irriga- 
tion and abundant drainage represent the links of a 
chain forged by necessity. A faultless asepsis has 
often enabled us to do away with both irrigation and 
drainage." 

One of our best auxiliaries in securing the rapid heal- 
ing of wounds is to render development and prolifera 
tion of infectious material an impossibility — although 
we also must be mindful of the fact that such conditions 
do not and cannot obtain in perfectly aseptic wounds. 
It must be remembered that normal healthy human tis- 
sues, and especially those through which the blood and 
lymph are circulating freely and properly, constitute 
very poor media for micro organic development, — in- 
deed there can be very little doubt but that such tissues 
are endowed with more or less inherent germicidal pow- 
er, as we have shown in a previous paper. But the stag- 
nation and subsequent alteration of blood or serum of- 
fer excellent culture media and therefore it becomes a 
duty to institute, in other than aseptic wounds, such 
processes as will tend to prevent the accumulation of 
altered secretions or morbid discharges in the wound 
area. This we can secure in two ways; that is, either 
by exact coaptation of well-nourished wound margins or 
else, where this is not possible, by removing secretions 
and conducting them without the wound area. This 
last condition may be secured by the open method, the 
method of secondary suture or else by drainage direct. 
In the first, the open method, healing will be slow; in 
the second or method of secondary suture, employed 



310 

and modified by Bergmani], Nugsbaum, Spengler and 
Helferich, the wound is left open for one or two days 
and then closed by sutures — it is claimed to unite the 
advantages of the open method and that of exact coap 
tation; the third method is that of drainage by means of 
drainage tubes or gauze. These tubes are seldom al- 
lowed to remain in the wound longer than forty eight 
hour@, except in case of grave infection. 

Theoretically we may say positively that drainage is 
useless in a perfectly aseptic wound. If the wound is 
aseptic the secretions following an operation or an in- 
jury contain nothing capable of causing sepsis, they will 
be absorbed with no disagreeable consequences and with 
no disturbance to either the wound or the general health 
of the patient. But in the event of exposure of large 
surfaces and irregular wounds a slight contamination is 
usually to be foreseen and expected, as well as met by 
proper means; these are usually afforded by proper 
drainage tubes allowing facile discharge of all possible 
elements of future decomposition and infection. 

Small superficial wounds, where complete approxima- 
tion of the wound surfaces can be secured, do not need 
drainage. But deeper wounds, such as may be adapted 
for either complete or partial primary union, must be 
drained so that secretions may not accumulate after 
union and compression have been instituted. In these 
cases drainage by tubes is probably preferable. Drain- 
age is also indispensable in all acute, progressive, sup- 
purative processes where an egress may thus be pro- 
vided for pus, sloughing tissue and morbid discharges. 



311 

Probably nothing is in every way better adapted for 
such purposes than the pure black gum or caoutchouc 
tubing cut into proper lengths aiid preserved in an up 
right position in a 1:20 carbolic acid solution. 

It can be engraven upon the memory that properly 
prepared aseptic rubber tubes are seldom, indeed we 
may 8ay never, capable of causing irritation. Any in- 
creased discharge or other untoward phenomenon is due 
to infection introduced within the wound by some 
means, usually by means of the tube itself. In aseptic 
wounds the function of the drainage tube is gone at the 
end of about twenty* four hours because oozing has usu- 
ally terminated by that time; although it is more fre- 
quently kept in until the change of the lirst dressings in 
order to avoid the disturbance of wound and dressings 
consequent upon the removal at an earlier period. 

But we repeat, in perfectly aseptic wounds drainage 
is unnecessary, unless discharge is excessive. Gerster 
goes even beyond this, he says: ''Even in operations 
where we are not absolutely certain of the aseptic con- 
dition of our wound we can often dispense with the use 
of drainage tubes, and not incur any serious risk. Berg- 
mann first demonstrated that a wound of doubtful asep 
ticity can yet be made to heal by primary adhesion. 
He passed his suture points through the edges of the 
wound and all its recesses down to the bottom with 
iododoform gauze. Over this was placed the usual outer 
dressing. Through the capillary action of the gauze 
copious oozing of serum was encouraged, which in about 
sixty hours lost its sanguinolent character, whereupon 



312 

the packing being extracted the suture points left in situ 
were closed, and the wound was seen to heal in a man 
ner little differing from primary union. Undoubtedly, 
much of the success of this plan of packing and secon- 
dary suture is to be attributed to the iodoform, which 
has triumphantly withstood various attacks upon its re- 
putation." 

Still another modification of this form of drainage is 
now extensively employed in abdominal surgery, where, 
on account of much unavoidable denudation or acciden- 
tal infection, copious oozing is to be expected. Mikulicz 
was the first one to employ the iodoform gauze packing 
successfully in the abdominal cavity, and his plan has 
met with widespread and deserved acceptance. First, 
it does away with the use of the drainage tube, and sec- 
ondly, its contact with the peritoneum causes just 
enough adhesive irritation to insure after its removal 
rapid agglutination of the raw surfaces. Immediate 
closure of the wound can be practised after the extrac- 
tion of the packing. 

Thanks also to Schede's method of treatment under 
the moist blood crust we have, as it were, the choice of 
a middle course between the open treatment and drain- 
age. Kocher says of it: "When the immediate coap- 
totion of the wound margins is impossible it utilizes the 
blood effused into the wound to fill the cavity. The 
wound is allowed to fill with blood, the edges are but 
partially united by sutures, and the rest is covered with 
impermeable tissue. Where neither primary nor sec- 
ondary suture is possible this method is much preferable 



818 

to the simple open wound treatment, with reference to 
the duration of the healing, by favoring the cicatrizing 
process." 

But more frequently than not all of these agents and 
means which we have described are applied in operative 
work where the wound is made by the surgeon himself 
and most of the conditions are directly under the con- 
trol of the operator; hence it is more possible to secure 
asepsis, to prevent an intense or prolonged infection. 
There are times as well when one must operate under 
other than these favorable circumstances, when exten- 
sive micro-organic invasion of the tissues has already 
occurred or else when such invasion cannot well be 
avoided, or when the site of the operation is also the 
focus of an infection which is either intense in nature or 
long in duration. In such cases we have to vary the 
treatment with the conditions to be met; more frequent- 
ly when such wounds are not aseptic we can secure very 
good results by the use of antiseptic irrigation of the 
wound area, the application of moist chemically steri- 
lized compresses or other dressings which are frequently 
changed unless specially contra-indicated; then the 
wound can be sutured after the infectious matarial has 
been eliminated and the line of union, in fact the whole 
of the wound area, dusted with a dry antiseptic powder 
dressing. 

Moselig von Moorhof, by the use iodoform in 1880, 
introduced a new form of wound treatment. Iodoform, 
per se, is a comparatively bland and inert body; but con- 
tact with decomposing organic matter effects its own de- 



314 

composition, liberating free and elementary iodin by 
which the ptomaines and toxalbumins are fixed and in- 
cidentally further micro-organic development arrested, 
as De Ruyter has shown. Both of these effects are due 
to the presence of the liberated iodin rather than to 
iodoform itself. This peculiar effect is only possible in 
the presence of decomposition and such products as 
ptomaines and toxalbumins. But the latter are directly 
the result of vital activity on the part of bacterial organ- 
isms, any condition in which they are found must neces- 
sarily be septic in nature; therefore iodoform would be 
practically and antiseptically inert in an aseptic wound. 
It is for this reason that Kocher gays that iodoform has 
no place in the aseptic treatment of wounds. In wounds 
appropriate for the aseptic treatment he further says 
that its employment is senseless; on the contrary, the 
wound maybe directly infected by its application. But 
it is the most active of all drugs for counteracting be. 
ginning and advanced decomposition and hence is to be 
used on wounds where decomposition must be expected 
from insufficient asepsis. Bergmann's mode of using 
the drug has been shown by the investigations of De 
Ruyter to be the best — namely, to pour into the wound 
a solution of iodoform (ten parts) in ether (twenty parts) 
and alcohol (eighty parts). 

Dry Pulverulent Dressings. 
All modern wound or other surgical dressings have in 
view one primal, or rather a two-fold object, namely 
the exclusion of germs or their destruction or inhibition 
when access has already taken place. 



315 

Albuminoid substances, such as the blood, serum and 
various tissues of the body, will decay or become putrid 
under certain conditions. The active causes of such de- 
composition are microorganisms; for the growth and 
development of such organisms certain definite condi- 
tions, or combinations of conditions, must pre-exist, for 
micro-organisms are no less amenable to vital and nat- 
ural laws than the higher and more complex organisms, 
up to man himself.— as Browning says: 

''From life's minute beginnings, up at last 
To man, the consummation of His scheme." 

Certain conditions must exist or the germ dies. For 
the growth and development of micro-organic life we 
may say that at least three conditions must co exist; 
these are (a) a certain definite temperature, (5) the 
presence of more or less moisture and (c) the presence 
of pabulum. Absence of any one will result in inhibi- 
tion of vital activity if not in actual death of the germ. 
In the absence of the two first conditions growth and 
development are inhibited; absence of the last, or ab- 
sence of all three conditions induce the ultimate death 
and destruction of germ life. 

As far as temperature is concerned we have previously 
shown that few if any germs are really actually destroyed 
by even extreme depression of temperature while ex- 
treme elevation invariably effects such result. Indeed 
exposure for even a few minutes to moist heat at the tem- 
perature at which water boils (100° Centigrade or 212° 
Fahrenheit) will not only destroy almost every known 



316 

variety of pyogenic and especially pathogenic germ 
life but their spores as well. The most favorable tem- 
perature for their growth is from 95° to 100° Fahren- 
heit, that is, about the normal bodily temperature. It 
must be obvious that the application of a sujBcient de- 
gree of heat to the body for the purpose of effecting 
sterilization would seriously impair and indeed destroy 
the vitality of the very tissues to whose normal and 
physiological development we are endeavoring to con- 
tribute. True the germ would be destroyed, but so also 
would the tissues to whose preservation and conserva- 
tion our energies were supposed to have been directed. 
Obviously then neither elevation nor depression of tem- 
perature can be made uise of in wound treatment, or in 
the sterilization of any infected area of the human 
body. Such, however, is splendidly adapted to the dis- 
infection of instruments, bandages, dressings, etc. 

As far as the second proposition is concerned, the 
presence of more or less moisture, this can be somewhat 
controlled. For this very reason absolutely dry opera 
tions, as Gerster and other eminent operators agree, 
are much more rapid in their processes of repair and 
healing because of the aseptic condition consequent up- 
on such absence of moisture. This is the chief virtue 
of the galvanocautery, the therrao cautery, in operative 
work; that the high degree of heat not only promptly 
destroys all germs present but also thoroughly dessi- 
cates the tissues of the wound with which the knife 
comes in contact, forming an absolutely dry and imper- 
vious eschar beneath which the process of repair pro- 



317 

ceed.8 in an almost ideal manner, because of the ab- 
sence of micro organic interference with such normal 
process. 

Gerster says in his classic work upon ''Aseptic and 
Antiseptic Surgery:" "Small or comparatively small 
wounds, admitting of an exact coaptation of the deeper 
as well as their superficial parts by suture, are exquis- 
itely fit for this method of treatment. Plastic opera- 
tions about the face may serve as a fair type. 

'^Certain finely powdered substances, as iodoform or 
subnitrate of bismuth, have the quality of rapidly in- 
spissating blood and serum to a dry crust. Accordingly, 
after the hemorrhage has been controlled and the 
wound closed by suture, a quantity of the substance 
chosen is dusted over the sutures. No further dress- 
ings are applied. The escaping bloody serum forms a 
paste with the powder, which by its sterilizing property 
prevents decomposition, while the paste remains moist. 
Free access of air will hasten exsiccation; and the dry, 
hard crust once formed will securely prevent further 
ingress of dust into the wound. In cases where the 
powder is washed away by profuse oozing, the dusting 
has to be repeated every half hour after the operation, 
until the object — the formation of a dry crust-— is ac- 
complished " 

Professor Friederich von Esmarch, Professor of Sur 
gery to the University of Kiel, in a copy of his Hand- 
buck aer Kriegchirurgischen Technik which he recently 
sent me, mentions iodoform, bismuth subnitrate, naph- 
thalin, zinc oxid, iodol, sozoiodol, dermatol, aristol, 



318 

di iodo-thio-resorcin, 8ulphaminol and salol among the 
antiseptic powders for use as dry dressings. Of these 
Gerster prefers the first two. The chief objections to 
iodoform are, first, its disgusting, inevitable, persistent 
and nauseating odor: second, its feeble germicidal ac- 
tivitj'', possessing none uotil its decomposition liberates 
free iodin; third, it produces marked toxic effects in 
certain persons (elderly persons seem specially predis- 
posed) — these toxic effects it seems to manifest espe- 
cially upon the central nervous system and therefore its 
employment should be surrounded by great care and ac 
curate dosage. It is almost indispensable, however, in 
the treatment of accessible tubercular areas and has, as 
has been mentioned, given very good results in septic 
wounds. As to the subnitrate of bismuth its chief ob- 
jection is the comparative weak germicidal power, 
Broome, Bernays, Msstin, Martin, Senn, Marks, the 
author himself and a host of others have found a com 
bination of phenol and boric acid to be a superior dry 
d resiling. This combination (a most excellent prepara- 
tion of which is furnished in Sennine) possesses in a 
marked degree the superior antiseptic virtues of its 
constituents— indeed even Lister himself now declares 
the supremacy of carbolic acid over every other germi- 
cide. The pulverulent and non-irritating properties of 
Sennine give it valuable exsiccating and inspissating pow- 
ers which are absolutely indispensable in adry dres-ing. 
Its antiseptic qualities give it valuable inhibiting and 
sterilizing properties; should hypersecretion by any chance 
supervene it is thus enabled to completely sterilize the 



319 

morbid discharges which would otherwise form a most 
fertile and undesirable nidus for micro-organic develop- 
ment. As a well-known authority upon antiseptics and 
asepsis has said: '^Capillary attraction, exerted by a 
dry absorbent dressing, is perfectly adequate to drain 
an aseptic wound of its serous discharges and the rapid 
drying and crusting of these dressings is just the thing 
we want to seal a sweet wound against the possibility 
of subsequent infection from without." And juet here 
is where the function, power and advantages of such 
dressings as Sennine are most desirable; complete steril- 
ization, and the presence of the antiseptic dessicant, ab- 
solutely insure against subsequent infection. 

We know that the excellent antiseptic value of our 
highly absorbent dressings depends as much upon their 
valuable qualities of promoting and hastening rapid 
evaporation as upon their chemical properties. We 
have employed exsiccation or dessioation as a means of 
preservation for ages; for centuries men have erapiri 
cally cured and preserved perishable food products in 
the same manner and the testimony of experience is 
sufficient to attest the efficacy of the process. We have 
discussed in detail the effect of exsiccation upon micro- 
organisms in a previous paper (Paper VII). It is also 
interesting to note in this connection that Schlange has 
shown that cultures, on moist pads of cotton, of the 
bacillus of green pus were aggressively prolific when 
evaporation was checked; but such proliferation was 
immediately stopped upon exposing the pads freely to 
the air and thus allowing them to become dry through 



3?0 

loBS of moisture. Moreover, Schimmelbusch distinctly 
claims, with the best of reasons, that the efficacy of 
highly absorbing and rapidly drying dressings, even 
though containing moderate amounts of schizomycetes^ is 
far greater than is the case with materials which lack 
such valuable properties even though they he faultlessly 
impregnated. 

We have now reached the consideration of the third 
condition, namely, the presence of pabulum. Normal 
healthy tissue is antagonistic to the growth and devel- 
opment of germs; so also are normal healthy secretions. 
Ergo^ healthy tissues and secretions do not contain mi- 
cro-organic pabulume Normal, healthy intra vascular 
blood possesses marked germicidal powers, probably 
due, as Vaughan suggests, to the contained nuclein or 
nucleins; but when such blood, drawn from the vessels, 
is allowed to stand it rapidly loses its usual alkaline re- 
action and becomes acid in character and in reaction 
upon litmus; concomitant with this loss of alkalinity is 
its loss of germicidal power, indeed such blood under 
these conditions is not only devoid of all germicidal 
power but even affords an excellent culture medium. 
So also, altered and morbid discharges form good cul- 
ture media in which micro-organisms develop and flour- 
ish because they find ample pabulum therein. To pre- 
vent the occurrence of this condition we must either 
prevent discharge from the wound or else if such occurs 
prevent its subsequent infection. This may frequently 
be done by means of absorbent drying powders which 
inspissate such discharges and keep the wound dry and 



321 

hence nearly aseptic. The presence of an antiseptic or 
inhibitory agent in such dressings will prevent the de- 
velopment of micro organisms altogether. If hyperse- 
cretion results, infection is almost certain to occur un- 
less the discharges be thoroughly and efficiently steril- 
ized and antiseptized. The functions of an ideal dress- 
ing are two-fold (a) to inspissate moderate discharges 
by absorption and subsequent evaporation of the liquid 
portion of such discharge and thus present a dry field in 
which micro-organic development is inhibited, or (d) 
when such discharge becomes profuse to prevent infec- 
tion by charging such secretions with antiseptics, or if 
infection has supervened to effect sterilization by the 
same agency. Many dry dressings possess only the first 
quality, the best possess the second as well— among 
these we might mention salol, naphthol, Sennine, and 
to a certain extent, iodoform. These, with the possi- 
ble exception of Sennine, have a comparatively low 
solubility in the wound discharges and hence possess 
very limited powers of penetration of wound recesses. 
Sennine by virtue of its greater solubility has powers 
which are more marked in this respect and hence it may 
be classed among the very best of all dry dressings for 
all purposes. The known hygroscopic properties of car- 
bolic acid give this product of carbolic and boracic acid 
the inspissating power which is so desirable in a dry 
dressing; being a powder its power 'of absorption is in- 
creased mechanically to some extent by virtue of a mod- 
ified form of capillary attraction. To this is added the 
marked antiseptic, bland and non-irritating properties 



322 

of boric acid and the marked germicidal power of car- 
bolic acid which has been almost entirely robbed, by 
the combination, of its usual irritating qualities. Hence 
in this substance we have the two-fold function of an 
ideal antiseptic dry dressing fulfilled in a manner almost 
ideal in itself. These facts are fully borne out by a 
comparatively extended clinical experience, in addition 
to the strong scientific foundation upon which they are 
reared. 

The present is distinctively an age of dry dressings 
and from the present outlook the future is to be more 
so, if not, indeed, exclusively an age of dry dressings. 
In order to gather definite information upon this point 
the writer has for the past six months or more been in 
communication with the leading surgeons of the world; 
from this correspondence he has gleaned a symposium 
of their respective opinions upon the value of dry dress- 
ings in general. In each case the surgeon expressed 
the opinion knowing that it was to be used as his own 
expression upon the subject, for so he was informed, 

Thomas Annandale, Kegius Professor of Clinical 
Surgery, University of Edinburgh: "I prefer dry dress- 
ings in all cases except where owing to large cavities 
and other conditions drainage is required." 

Thomas Bryant, London, England: *'I always use 
dry absorbent dressings for fresh wounds. * * * I 
finally dust the wound before closing it, with a powder 
composed of one part of iodol and four parts of pow- 
dered boracic acid." 

Victor Horsley, London, England: *'I use dry dress- 



323 

ings wherever possible and avoid hemorrhage as much 
as possible." 

W. W. Keen, Professor of the Principles of Surgery 
and Clinical Surgery, Jefferson Medical College, Phila- 
delphia; Surgeon to Saint Agnes' Hospital,. Philadel 
phia, Pa.: "I almost always use dry dressings, antisep- 
tic or sterilized, rarely wet." 

Nicholas Senn, Professor of the Principles of Surgery 
and Clinical Surgery, Rush Medical College, Chicago; 
Surgeon-General, Illinois National Guard; Surgeon in- 
Chief, Saint Joseph's Hospital, Chicago; Attending Sur- 
geon, Presbyterian Hospital, Chicago, 111.: "I prefer 
dry dressings in all operations for aseptic conditions; in 
all other cases I rely on solutions of carbolic acid or 
sublimate. In operations for open tubercular lesions I 
give iodine solution the preference." 

Roswell Park, Professor of Surgery to the Medical 
Department of the University of Buffalo; Surgeon to 
the Buffalo General Hospital; Consulting Surgeon to the 
Fitch Accident Hospital: "I would say that more and 
more as the months go by I am in favor of dry operat- 
ing and dry surgical dressings, and esteem that opera- 
tion to be the nearest approach to the ideal in which 
there is the least possible amount of fluid of any kind 
present, either blood or antiseptic solution. In fact I 
do not even use hydrogen peroxide now as I used it 
once." 

William Hunt, Surgeon to the Pennsylvania Hospital, 
Philadelphia: "I have been an earnest advocate of dry 
dressings almost since I entered the profession. One 



324 

of my earliest papers was in advocacy of them. I have 
never had any occasion to recede from such recommen- 
dations. Thanking you for the opportunity of answer- 
ing queries like yours, I am very truly yours," etc. 

C. H. Mastin, Mobile, Alabama: **I use dry dress 
ings in small wounds and in fact in all wounds where I 
can get exact coaptation. Here I use indiflEerently 
Bismuth, Aristol and sometimes Iodoform, but its odor 
is objectionable, and I do not think it possesses any ad- 
vantage over Aristol, Europhen or Boric Acid. I might 
add I use more Boracic Acid for small wounds, than 
anything else. Where I am unable to get exact coapta- 
tion, I am forced sometimes to use moist dressings. As 
a rule I prefer dry dressing, first covering with the 
selected articles (Boric Acid, Bismuth, Aristol or such 
articles as I prefer at the time), then several folds of 
gauze, (Iodoform, Mercuric, Boric, Eucalyptus or simple 
dry gauze) cotton, gauze and then bandage." 

D. W. Yandeil,Professor of the Principles of Surgery 
and Clinical Surgery to the Medical Department of the 
University of Louisville, Kentucky: "I like dry surgi- 
cal dressings where I can use them on perfectly dry sur 
faces which I can keep dry by complete drainage." 

Theo. A. McGraw, Professor of Surgery to the De- 
troit Medical College; Surgeon to Saint Mary's Hospi- 
tal; Surgeon to the Harper Hospital, Detroit, Michigan: 
''I aim to keep my wounds aseptic and am fond of the 
dry method of operating." 

Augustus C. Bernays, St, Louis Missouri: "I con- 
sider that the dry treatment of wounds is the ideal 



325 

method in all cases where an aseptic operation can be 
performed, where there is no sepsis before the operation 
and where there is no infection during the operation. 

'^Recently an excellent powder for the dry treatment 
of wounds has been put before the profession in a most 
convenient form under the name of 'Sennine.'" 

Frederic H. Gerrish, Surgical Instructor to the Fort- 
land School of Medicine; Professor of Anatomy to the 
Medical Department of Bowdoin College: *'I use car- 
bolic solution for the instruments and sublimate solu- 
tions for hands and the Held of operation, first scrubb 
ing these with hot water and soap Dry iodoform on 
the wound, and above this a voluminous dressing of sub- 
limate gauze have served me so well for so many years 
that I feel little disposition to abandon them for any 
new things which I have yet seen." 

E. H. Bradford, Instructor in Clinical Surgery to 
Harvard Medical School; Visiting Surgeon to the Bos- 
ton City, Children's and Samaritan Hospitals: "I pre- 
fer dry dressings in aseptic surgery in all cases where 
the wound is aseptic," 

George Wiley Broome, Frofessor of Surgery and 
Dean of the Woman's Medical College, St. Louis; Sur- 
geon to the Woman's Hospital, St. Louis. In a recent 
letter to the writer Doctor Broome said: 

"Any physician may see and appreciate the great 
value of dry dressings in surgical cases. I may go a 
little further and venture the prediction that the scien- 
tific surgery of the near future will not even include the 
now widely u&ed irrigating vessels in the instrumen- 



326 

tarium of the surgeon at all. Instead of irrigations the 
asepticity of a wound will be secured and maintained 
by dry sponging. In suppurating cases asepsis will be 
established by destroying the medium in which the 
pyogenic micro organisms grow and multiply, by the 
same means. The availability of any antiseptic is en- 
hanced in proportion to the degree of its inhibitory 
power. The inhibitory function can be performed per- 
fectly in a dessicated field only. Dessication can only 
be secured by means of dry, together with hygroscopic 
dressings. A suppurative inflammation with the pres- 
ence of pus, wherever found in the human body, must 
be treated by dry sponging, not by irrigation, so that it 
will only be a little while until the application of pow- 
ders possessing such power will be a universal practice 
among progressive surgeons. 

^'Latterly I have been using *Sennine' to dust over 
laparotomy wounds and have found it superior in many 
essential particulars to other antiseptic powders^'* 

In a recent paper entitled "Some Fresh Points in the 
Technique of Celiotomy^ Extra Peritoneal Abdominal 
Hysterectomy and Ideal Myomectomy,'^ read before the 
St. Louis Medical Society and published, April 7, 1894, in 
the Weekly Medical Review of St. Louis, he says 
further: 

"I am strongly partial to dry dressing and dry spong 
ing. I believe that one of the greatest achievements 
of scientific surgery belongs to the future in this partic- 
ular direction. When practical surgeons become more 
f?imili£i,r with the life, habits, growth and development 



327 

of the pyogenic microbes, then they will learn to ap- 
preciate more fully the importance of an early and ab- 
solute abandonment of the practice of irrigation and I 
furthermore wish to make this declaration now: that 
ideal surgery can, in the near future, contemplate the 
act of the irrigation of wounds and cavities only in the 
light of a revolt against the science of regeneration. I 
mean this statement for a sweeping one covering all 
cases, and especially pus cases, those very ones that 
are looked upon to-day as presenting the ideal condition 
for irrigation, dry sponging is the fresh point therefore 
that I wish to show, whether it be for a pyocelia or a 
suppurative otitis media, I care not which. Dry spong- 
ing and dry dressing will be the practice of the future. 
Dry sponging is more rational in every respect than the 
irrigating method or wet sponging. Dry dressings by 
means of powders have proven more satisfactory be- 
cause of their inhibitory power. 

"The relativ^e value of these powders is a subject I do 
not care to discuss further than to mention the very 
great value of iodoform in all tubercular processes and 
boracic acid and phenol in combination as an ideal an- 
tiseptic and dessicant. 

"You know that iodoform was first introduced to the 
profession by Mosetig Moorhof in the year 1880 and is 
composed of alcohol, iodine, carbonate of potash and 
water and its real merit, as an inhibitory agent depends 
upon its slow decomposition and the liberation of iodine. 
The latter acting in two different ways. The one is the 
antiseptic property of iodine destroying germ life, the 



m 

otker is the chemical property of iodine to eliminate the 
toxines rendering them insoluble and therefore unab- 
sorbable and thus innocuous to the system. The hygro- 
scopicity of the impalpable powder of boracic acid is 
too widely known to require explanation, and since the 
father of antiseptic surgery still clings to the use of 
carbolic acid I need scarcely consume your time in com- 
mending the inestimable value of a combination in 
powder form of boracic acid and phenol. These have 
been happily incorporated under the name of 'Sennine' 
and I know of nothing superior as a topical dressing to 
prevent parasitism and thus secure the early and rapid 
healing of a surgical wound." 

In order to obtain the very latest and most reliable 
views upon these subjects, the author has been in con- 
stant correspondence with many eminent medical gen- 
tlemen for some time. The correspondence has been 
peculiarly valuable, instructive and edifyiDg— indeed, it 
is a source of very great regret that space does not per- 
mit the publication of the correspondence in full. The 
author is deeply indebted for the uniform courtesy and 
patience with which he has been indulged by these pro- 
fessional gentlemen, the demands upon whose valuable 
time must have been multifarious. In almost every 
single instance there has been a marked display of that 
true scientific brotherhood in which each lends his aid 
freely and willingly to a brother investigator — indeed, 
the correspondence lias brought out in a remarkable de- 
gree that indissoluble tie of brotherhood and unity 
which binds the medical gentlemen of all ages, races 

d climes. 



329 

Professor Doctor Vinceat Czerny, Professor of Sur- 
gery to the University of Heidelberg:-— "I use, almost 
exclusively, gauze and wadding that has been sterilized 
with streaming steam. Both are first boiled in a 0.6 
per cent, salt solution and then sterilized in steam. 
The catgut is sterilized in 1 per cent, bichloride solu- 
tion. For disinfection of the hands we use Fuer- 
bringer's method. For disinfection of wounds we use 
the following: Iodoform gauze and cloth which has 
been sterilized and dipped in 10 per cent, iodoform- 
ether solution. For moist bandages we generally use 
1 per cent, of aluminic acetate." 

Professor Doctor Carl Gussenbauer, Professor of 
Surgery to the University of Prague: — ''In an 
swer to your question I would say that the asep- 
tic and antiseptic methods are in use in my clin- 
ic. Asepsis is secured by sterilization of the in- 
struments and of the materials used for ban- 
daging. For antiseptic • purposes I use the corrosive 
bichloride of mercury (1:1000), and for the intestine 
salicylic or boracic acid. For dry bandages and for the 
tamponade of wounds which have been infected, and 
also in cases of tuberculous accumulations, I use iodo- 
form. For moist bandages, when treating cases of 
acute purulent inflammation, I use the acetate of alum- 
inum. For ligatures I use catgut, and for stitching, 
carbolized silk thread. 

"We have recently made some other experiments 
with different antiseptics, but have found nothing more 
satisfactory than those mentioned. I hope that the^e 
few brief indications will be of service to you." 



330 

Professor Doctor Friederich von Esmarch, Professor 
of Surgery to the University of Kiel: — In answer to 
my letter, Professor Esmarch, who is without doubt the 
greatest military surgeon of the world, sent me a copy 
of his Handbuch der Kriegschirutgischen Technik, This 
work was offered in competition for the large prize to 
be awarded by the German Empress for the best work 
on the technique of military surgery. A jury consist- 
ing of Professor Doctor B. von Langenbeck, of Ber- 
lin; Professor Doctor Billroth, of Vienna, and Profes- 
sor Doctor Socin, of B^sle, awarded the prize to this 
work of Esmarch. It is undoubtedly one of the great- 
est, if not the greatest, work on military surgery in any 
language. In it Esmarch describes and prescribes in 
detail various preparations of phenol, sublimate, zinc 
chlorid, boric acid, aluminic acetate, salicylic acid, 
chromic acid, thymol, potassic permanganate, benzoic 
acid, iodic tri-chlorid, tri cblor phenol, chlorin, alum, 
aseptin, sulphates of zinc and copper, zinc sulpho car- 
bolate, aseptol, eucalyptol, oil of juniper, hydrogen 
peroxid, absolute alcohol, iodoform, bismuth subnitrate, 
naphthalin, zinc oxid, sozo iodol, derraatol, aristol, di- 
iodothio-resorcin, sulph aminol, salol, etc, as antisep- 
tics in the form of solutions or as dry dusting powders. 

Doctor Thomas Annandale, Regius Professor of 
Clinical Surgery to the University of Edinburgh: — 
^^First — In all cases of aseptic wounds, operative or 
otherwise, carbolic solution (1 :40) is used and the sur- 
face of the wound well douched with it. Before clos- 
ing the wound all fluids are pressed out, and then a 



3Sl 

piece of muslin which has been kept in a carbolic solii 
tion (1:40) is applied next the wound, having the fabric 
previously well-squeezed so as to leave it just damp. 
0\rer this one or more layers of wood wool or corrosive 
wool, according to the probable amount of serous or 
other discharge, are applied and all are kept in position 
by a ^oit flannel bandage. 

The dressing is not interfered with until — 

a. Any discharge shows through the dressing. 

b. Any rise in temperature. 

c. Irritation or swelling felt by the patient in the 
part. 

Second — Septic wounds are treated by thorough wash- 
ing with carbolic solution (1:20); by the free use of 
iodoform; by the application of charcoal poultices, in 
which I have great faith; and, in the case of the limbs, 
the antiseptic bath is used when possible." 

Doctor John Chiene, Professor of Surgery to the 
University of Edinburgh; — ^'Thorough preparation of 
the skin of the patient, surgeon and assistants with 
soap, water, turpentine and methylated spirits, followed 
by 1:20 carbolic acid. Instruments boiled and then laid 
in 1 :20 carbolic acid. Dry corrosive sublimate dress- 
ings; swabs, not sponges, of gauze, or wool enclosed in 
gauze (as shown me by Mr. Cotterill, Assistant Sur- 
geon, Edinburgh Royal Infirmary); raiely use drainage 
tubes, careful pressure taking the place of drainage, 
taking great care to arrest haemorrhage at the time of 
the operation." 

Dr. Thomas Bryant, London, England: "I always 



332 

use dry dressings for fresh wounds and of these I prefer 
the wood wool tissuej that is wood wool mercuriated 
and enclosed between two layers of gauze. 

'*I employ warm or hot water stained of a cherry 
color with the tincture of iodine to saturate the sponges 
I use in operations; and always apply to the surface of 
a wound, before its dressings are applied, a sponge 
wruDg out in very hot iodine water to stop capillary 
oozinga I finally dust the wound before closing it, with 
a powder composed of one part iodol and four parts 
powdered boracic acid. 

"I usually suture my wounds with fine chromicized 
catgut or silk rendered aseptic by boiling in carbolic 
water and preserved on a metal winder in pure alcohol. 

"Iodoform gauze I apply to the surface of the wound 
beneath the wood wool tissue. I, in all deep wounds, 
introduce a drainage tube of rubber for one or two days 
and rarely dress wounds for the first three days, if there 
are no indications for interference, 

*'In large wounds I use a simple strip of piaster ap- 
plied between the sutures to keep the edges in apposi- 
tion. Most of my wounds heal by ^quick union.' " 

Dr. Victor Horsley, London, England: "I use steri- 
lized water. Five per cent carbolic solution for my in- 
struments after sterilization by boiling. For disinfec- 
tion of the hands 1:500 perchloride of mercury. In 
cases of any doubt I irrigate with weak solutions of mer- 
cury, 1:1000 to 1:4000. 

"I use dry dressings wherever possible and avoid hem- 
orrhage as much as possible." 



333 

Dr. Reginald Harrisoo, Surgeon to Saint Peter's 
Hospital; Hunterian Professor of Pathology and Sur- 
gery, Royal College of Surgeons; London England: 
''Among8t the uses ot antiseptics must be included 
their applications to operations involving the urinary 
apparatus. Recent researches, based upon bacteriologi- 
cal observations, show that the urine is capable of be- 
ing acted upon in the course of its excretion as to render 
the occurrence of rigors and fevers following lesions 
and abrasions of the urethra, as after internal urethrot- 
omy, divulsion, or the use of catheters and bougies, 
either rare or innocuous. This process is usually re- 
ferred to as sterilization of the urine and was first put 
into prominence by Dr. E. R. Palmer of Louisville, Ky,, 
chiefly with the use of boracic acid administered inter- 
nally as a preliminary to the operation of internal ure- 
throtomy. For this purpose, as well as for other oper- 
ations of a like nature, for two or three days previously 
I usually administer from five to ten grains of boracic 
acid in water every four hours. My results in thus 
preventing rigors and fever correspond with those of 
Dr. Palmer. This action of boracic acid is probably 
due to its being eliminated largely by the urine and 
there acting as a protective against bacterial develop- 
ment and propagation. Quinine, salol and hyposulphite 
of soda act much in the same way. In uncomplicated 
cases of purulent cystitis the last-mentioned chemical 
in half-drachm doses administered three or four times a 
day in water will often speedily clear the urine of pus 
and all traces of bacteria. Copaiba, sandal wood, sali- 



334 

cylic acid and cubebs have a similar, though probably 
feebler action on the urine as antiseptics. Amongst 
local antiseptics, solutions of quinine and perchloride of 
mercury are amongst the best for washing out the blad- 
der. The former may be used in the proportion of two 
grains to the ounce of water and the latter not stronger 
than 1:6000. Carbolic acid as an injection for washing 
out the bladder often causes intense irritation when 
used in sufficient strength to act as a bactericide. 

"These are the drugs I usually employ as antiseptics 
in lesions and purulent conditions involving the urinary 
tract." 

Dr. W. W. Keen, Professor of the Principles of Sur- 
gery and of Clinical Surgery to the Jefferson Medical 
College of Philadelphia; Surgeon to Saint Agnes' Hos- 
pital, Philadelphia, Pa : "I have no especial antiseptic 
formulae or I would gladly give them. I employ com- 
monly carbolic acid and bichloride solutions. I almost 
aiwajs use dry surgical dressings, antiseptic or sterilized, 
rarely wet. I have practically abandoned marine 
sponges and use sponges made of dry bichloride or ster- 
ilized gauze rolled into balls about the ordinary size." 

Dr. Nicholas Senn, Professor of the Principles of 
Surgery and of Clinical Surgery to tiie Rush Medical 
College of Chicago; Surgeon-in-chief to Saint Joseph's 
Hospital of Chicago; Attending Surgeon to the Presby- 
terian Hospital, Chicago, 111.: "I prefer dry dressings 
in all operations for aseptic conditions. In all other 
cases I rely on solutions of carbolic acid or sublimate. 
In operations for open tubercular lesions I give iodine 
solution the preference." 



335 

Dr. Arpad J. Gerster, Professor of Surgery to the 
New York Polyclinic; Surgeon to the German Hospital, 
New York City; Surgeon to Mount Sinai Hospital, New 
York City: "I have no favorite antiseptic formulas. 
The ones I use you will find mentioned in the last edi- 
tion of my book on the same subject and in a pamphlet 
mailed to your address to day which contains also an 
exposition of the principles governing the use of dry 
and moist dressings." 

Dr. Gerster has been so freely quoted in the preced- 
ing pages and his work is so well-known that his opin- 
ions may be easily inferred. 

Dr J. William White, Professor of Clinical Surgery 
to the University of Pennsylvania, Philadelphia, Pa.: 

'•My dressings are as follows: 

*'Skin cleansed with 
"(^) Soap and water. 
''{d) Alcohol. 
^'{c) Carbolic acid 1:40. 
"(^) Sublimate 1:1000. 

"Fponges are placed in a solution of 1:50 carbolic 
acid in 1:2000 sublimate. As little sponging or irriga 
tion as possible, except in cases where operative area is 
alwa) s infected. Then a douche of 1:20 carbolic acid 
in 1:1000 sublimate. Drainage tubes usually dispensed 
with in clean wounds, 

'^Permanent dressings of two varieties: 

'*1. (a) Iodoform dusted thickly over edge of wound 
and over skin for some distance. 

"(^) Moist crumpled iodoform gauze. 



336 

"(^) Moist crumpled sublimate gauze. 
"(^) Sublimate gauze bandages. 

^^2, Double cyanide dressing as recommended by 
Lister with his latest modifications. 

"Results about equally good with these two methods. 

"In most general clinical work and in the majority 
of all operative work a mild but thorough antisepsis 
with a minimum of sponging, irrigation, etc., is to be 
preferred." 

Dr. John Ashhurst Jr., Professor of Surgery and of 
Clinical Surgery to the University of Pennsylvania; 
Surgeon to the Pennsylvania Hospital; Surgeon to the 
Children's Hospital of Philadelphia, Pa.: "I beg to 
say that an account of the antiseptic measures which 1 
employ may be found in the sixth edition of my *Prin- 
ciples and Practice of Surgery' recently published by 
Messrs. Lea Brothers and Co., of this city," 

Dr. Ashhurst therein recommends "antiseptics diluted 
with good common sensed 

Dr. J. M. Barton, Surgeon to the Jefferson Medical 
College Hospital; Surgeon to the Philadelphia Hospital: 
"I am in the habit of using at my clinics at the Jef- 
ferson College Hospital and the Philadelphia Hospital, 
where I have experienced assistants, aseptic measures in 
most of my operations, first sterilizing the parts, the 
sponges and the hands of the operator and assistants 
with some of the well known antiseptics, usually bi- 
chloride of mercury (1:1000), and preparing the instru- 
ments by boiling. 

"During the operation boiled water alone is used, and 



337 

the wound is dressed with dry gauze sterilized by heat. 
When we cannot expect to remove the blood-stained 
gauze at the end of twenty-four hours, as when an open 
wound ig packed with it, iodoform gauze is used. 

"In out of- town operations, where I cannot have my 
usual assistants, I rarely attempt aseptic work, but be- 
fore, during and particularly after an operation, I use a 
strong solution of bichloride of mercury freely to the 
wound. The instruments and the towels surrounding 
the seat of operation are sterilized with a 5 per cent, 
solution of carbolic acid. 

"I have put up in dozens, bottles each containing one 
ounce and a half of carbolic acid and one ounce of alco- 
hol. One of these I carry with me to each of my pri- 
vate operations and empty into a quart of warm water, 
making a 5 per cent, solution, in which the instruments 
lie, in their tray, until the patient is under ether. Tow- 
els are then wetted in the solution, which removes it 
from the instruments, and the towels are used to sur- 
round the site of the operation and to cover the instru- 
ment table. 

"The addition of the alcohol causes the carbolic acid 
to fully and quickly dissolve in the water. 

"Dry dressings, sterilized by heat, are carried with 
me and applied while the parts around the wound are 
still wet with the mercurial solution. 

"When the wound is open and infected, I use wet 
dressings, usually gauze wet with the mercurial solu- 
tion, being careful to fully cover the dressing with mac- 
intosh to prevent evaporation strengthening the solution 
and causing blistering." 



338 

Dr. William Hunt, Surgeon to the Pennsylvania 
Hogpital, Philadelphia, Pa.: "I have no favorite form 
u^8B for antiseptic procedures; varying strengths of cor- 
rosive chlorides, carbolic acid and hot water meet all 
the requirements according to my experience." 

Dr. Roswell Park, Professor of Surgery to the Med- 
ical Department of the University of BuiBEalo; Surgeon 
to the Buffalo General Hospital; Consulting Surgeon to 
the Fitch Accident Hospital, Buffalo, N. Y.: "My fa- 
vorite application to the parts to be operated on, and 
which I have applied for at least twenty-four hours pre- 
viously, when opportunity permits, is of green soap 
with 5 per cent, of lysol or of hydronapthol, perhaps a 
little glycerin being added to the whole mass. This I 
have applied on compresses, with rubber tissue outside 
to prevent evaporation . 

*'In my portable operating outfit, which I carry to all 
country operations, I take a saturated alcoholic solution 
of hydronaphthol for use upon instruments, ligatures, 
etc , to be used during the operation. These I place in 
boiling water and add to it a little of the alcoholic so- 
lution. The hot water takes up so much of it as it can, 
making thereby a saturated watery solution, and the 
rest is simply wasted, the loss, however, being insignifi- 
cant. 

"I am now using for almost all cases, as a means of 
sterilizing the operator's and assistants' hands, ordinary 
flour of mustard, ^ * * the process being about as 
follows: 

"With a nail brush the hands are thoroughly scrubbed 
with green soap, then it is rinsed off. A teaspoonful 



339 

or so of the flour of mustard is then put on the hands 
with a little water and thoroughly rubbed into all 
creases and parts about the finger nails, and thus manip 
ulated for three or four minutes. The result is the 
most perfect sterilization of the hands, with the least 
immediate after disturbance of the skin that can possi- 
bly be produced by any means known to me. You will 
remember that the oil of mustard is one of the most 
powerful antiseptics known; in fact, all of the aromatic 
oils share this property with it. Quite recently I have 
seen cinnamon recommended in the same way, and I 
have no doubt that powdered cinnamon would be as 
good as mustard, but not so easily procured. One ad- 
vantage of the latter is that it is at hand in almost every 
household. It is more than an ordinary antiseptic. 
* * * Mustard can always be recommended as a de- 
odorizing agent when the hands have become contam- 
inated with any foul-smelling material. For my own 
part, I shall have no fear in going at once from the dead 
room to the operating table, providing my clothing car- 
ried nothing, if I could resort to this means of disin- 
fection and sterilization. 

**It is, in my estimation, extremely desirable to have 
a good combined styptic and antiseptic. For this pur- 
pose I most highly recommend to you a 5 per cent, so- 
lution of antipyrin. This I have used for several years, 
after having first carefully tested it as an antiseptic. In 
solution of this strength it is a fairly powerful germi- 
cide, and if once carefully prepared with sterilized wa- 
ter, and kept protected from ordinary atmospheric con- 
tamination, can be used with impunity so far as danger 
of infection is concerned. As a styptic it is more pow« 
erful than any medicinal substance with which I am 
familiar. I have used it on and in the brain, on and in 
the abdominal viscera, have injected it into the bladder^ 
have used it in the nose, in fact, in any and every place 
where oozing has given me any trouble, and have 



340 

learned to have a firm faith in its valuable properties. 
In my clinic I have always at hand a spray bottle from 
which it can be sprayed upon any oozing surface, and it 
is used almost daily. To many others, at home and 
abroad, I have demonstrated its properties in this direc- 
tion, and have never known it to give anything but sat- 
isfaction." 

Dr. C. H. Mastin, Mobile, Alabama: "As to anti- 
septic formulae, I rarely, if ever, confine myself to any 
one special formula. Sometimes I 'use mercuric bi- 
chloride, sometimes hot water, and now and then 
Thiersch's boro-salicyiic lotion; this last I prefer in ab- 
dominal sections. When I use mercuric bichloride, I 
use it as the case may be from 1,000 to 12,000 strength. 

^^I never use 'protective' unless in those cases where I 
resort to a moist dressing, and then I use oiled silk, 
waxed paper, or thin rubber. I do not see any special 
advantage of Lister's mackintosh over any one of the 
substitutes I have mentioned. Before all operations I 
have the skin clean, using green soap with brush to 
scour it thoroughly, then mercuric bichloric, 1:1000, 
1:2000 or 1:5000, as the case may seem to require; then 
wash it off with boiled water and alcohol or ether. / 
attempt to clean the parts. In other words, I render them 
aB near aseptic as possible, and rely more on this thaQ 
the antiseptic lotions, chemicals, etc., which are so ex- 
tensively used." 

Dr. Theo. A. McGraw, Professor of Surgery to the 
Detroit Medical College; Surgeon to S&. Marj's Hos- 
pital; Surgeon to the Harper Hospital, Detroit, Mich : 
^'I have little faith in antiseptics ^^^<?//yi?r /r^^/y^j^/^^- 
tic purposes, I aim to keep my wounds aseptic, and am 
fond of the dry method of operating. Usually before 
operating, I have the skin shaved with soap and water, 
then with ether, and finally with a 2 per mille solution 
of corrosive sublimate." 

Dr. Frederick H. Gerrish, Surgical Instructor to the 



34:1 

Portland School of Medicine; Professor of Aaatorny 
to the Medical Department of Bowdoin College: ''I 
use carbolic solution for the instruments, and sublimate 
solution for the hands and the field of operation, first 
scrubbing them with hot water and soap. Dry iodoform 
on the wound, and above this a voluminous dressing of 
sublimate gauze have served me so well for so many 
years that I feel little disposition to abandon them. 
Results have been so satisfactory with this treatment 
that I shall continue to follow the plan until there ap- 
pears more reason thanat present lor a change." 

Dr D. W. Yandell, Professor of the Principles of 
Surgery and of Clinical Surgery to the Medical De- 
partment of the University of Louisville, Ky.: '^The 
three antiseptics that I use in my practice are corrosive 
sublimate, iodoform and carbolic acid. The first and 
last I use in varying degrees of strength; the second 
usually in powder or on gauze. I do not use corrosive 
sublimate in abdominal sections." 

Dr. E. H. Bradford, Instructor in Clinical Surgery to 
the Harvard Medical School; Visiting Surgeon to the 
Boston City, the Children's and the Samaritan Hospi- 
tals, Boston, Mass.: ''1 can only say that I make use of 
very simple antiseptics. Corrosive sublimate (1:1000 — 
1:3000), iodoform in powder, aristol in powder, and 
peroxide of hydrogen of various strengths. Carbolic 
acid is used, of course, and for ointments, aristol and 
vaseline." 

Dr. J. McFadden Gaston, Professor of Surgery to the 
Southern Medical College, Atlanta, Ga.: "In septic 
conditions, my reliance has been chiefly upon the fol 
lowing, giving preference in accordance to the case in 
the order named: — 

"Labarraque's solution, with the addition of perman- 
ganate of potash. 

"Lugol's solution, diluted with varying quantities of 
boiled water. 



342 

Carbolic acid, one ounce; glycerine, three ounces and 
boiled water, one pint (more or less, to suit the case). 

"Spirits of turpentine, one ounce; camphor, one 
drachm, for first applications and afterwards, with ad- 
dition of like quantity of olive oil. 

^'Peroxide of hydrogen is often employed as prepara- 
tory to other measures. 

"My use of corrosive sublimate is limited to cleans- 
ing the skin in the field of operations." 

Dr. Henry R. Wharton, Demonstrator of Surgery to 
the University of Pennsylvania, Philadelphia, Pa.: 
"I fear I have no special antiseptic formulae. I use bi 
chloride solution (1:2000 or 1:4000) and, in special cases, 
boiled water for the irrigation of wounds. I use large • 
ly, in antiseptic dressings, the modified moist method; 
that is, applying next to the wound a few layers of 
gauze, wrung out in bichloride solution, over this a pad 
of dry bichloride gauze, and over this a pad of bichlo- 
ride cotton and a bandage. I also frequently use dry 
sterilized gauze, and think my results with it are equally 
good." 

Dr. J. E. Michael, Surgeon to the University Hospi- 
tal; Consulting Surgeon to the Presbyterian Eye, Ear 
and Throat Hospital, Baltimore, Md.: — "My method is 
to have the surface of the field of operation thoroughly 
cleansed with soap and water, then treated with ether 
or alcohol and recleansed, after which I have the part 
covered with a moist dressing of 1:1000 or 1:2000 bi- 
chloride solution for several hours prior to operation. 
I do not believe there is any necessity for applying an 
antiseptic solution to fresh tissues during an operation, 
but place my main reliance upon cleanliness and thor- 
ough disinfection of the seat of operation, as well as of 
hands, instruments and all other matter likely to come 
in contact with the wound. 

"My dressings are mainly simple sterilized gauze or 
iodoform gauze. In obstetric practice, save in the pre- 



343 

ventive preparation of the external parts involved, upon 
the lines laid down above, I make no use of antiseptics 
in normal cases. In instrumental and manipulative 
cases I depend upon douches of sublimate solution of 
the strength of 1:1000 to 1:10000, depending upon the 
parts involved." 

Dr. George Wiley Broome, Dean of the Woman's 
Medical College; Professor of Surgery to the Woman's 
Medical College; Surgeon to the Woman's Hospital, 
St. Louis, Mo. (See his remarks quoted under the dis- 
cussion of "Dry Pulverulent Dressings"). 

Dr. A. C. Eernays, Professor of Anatomy, Woman's 
Medical College, St. Louis, Mo.: "The following are 
some of my favorite formulae: 

^ Collodii, flgiv. 

Hydrargyri bichloridi, - - gr.j. 

M. 

S. To be used with a brush over stitches and in- 
cision so as to seal wound. 

R Acidi Borici. 

Bismuthi subnitrici, - • aa S^j. 

M. 

S. To be dusted on the incision very profusely so 
as to cover up the stitches. 

"Recently an excellent powder for the dry treatment 
of wounds has been put before the profession in a most 
convenient form under the name of SecniDe." 

The author himself will add that he has secured with 
the dry dressing vrhich Dr. Bernaye mentions (Sennine, 
a combination of phenol and boric acid) most excep- 
tiocal results in cases amenable to dry treatment — in- 
deed, in one case of accidental incised wound of the 
hand in which he was himself his own patient, the pro- 
cess of repair was naught less than an ideal one. These 
results, as we have previously noted, have been corrob- 
orated by a large number of eminent medical gentle- 
men. 



344 

We may summarize some of these statements and re- 
searches as follows, bearing in mind that this is by no 
means complete otherwise: 

Cahbolic Acid. — Gussenbauer, Esmarch, Lister, An- 
nandale, Senn, Barton, White, Chiene, Horsley, Ger- 
rish, Gaston, Hunt, Keen, Yandell, Bischoff, Bar, 
Fritscb, Winckel, Lucas Championniere, Kocher, Gers- 
ter, etc. Used exclusively by: Lister, Chiene, Annan 
dale, Horsley. BischofP, Fritsch, Winckel, Lucas-Cham- 
pionniere, and others. 

Corrosive Sublimate.— Czerny, Gassenbauer, Es 
march, Keen, Barton, Hunt, White, Bernays, Michael, 
Wharton, Bradford, Gerrish, Gaston (only for the pur- 
pose of cleansing the skin in the vicinity of operation), 
Senn, McGraw, Yandell, Harrison, Gerster, Mastin, 
Kocher, etc. Used exclusixely by: McGraw, Michael 
asd Wharton. 

Iodoform. — Esmarch, Czerny, Gussenbauer, Michael, 
Bradford, Gerrish, Yandell, Barton, White, Mastin, 
Gerster, Kocher, etc. 

Sennine — Broome, Yarnall, Bernays, Heine Maik^, 
Mastin, Martin, Morse, Buchanan, etc» 

BoRACic Acid,— Harrison, Mastin, Bernays, Kocher, 
Buchanan, etc. 

loDiN.— Senn, Bryant, Gaston, etc. 

Bismuth Subnitrate. — Esmarch, Kocher, Bernays, 
Mastin, etc. 

Hydronaphthol.— Park, Flower, etc. 

Salol — -Esmarch, Harrison, etc. 

Hydrogen Peroxid —Bradford, Gaston, etc. 

Aristol — Bradford, Mastin, etc. 

loDOL. — Esmarch, Bryant, etc. 

Mustard.— Park. 

Antipyrin.— Park, etc. (Used as an antiseptic 
styptic.) 

Double Cyanid of Zinc and Mercury.- — White, etc. 



AUTHORS. 



Abbot, 95, 140, 152, 184, 211, 212 
Adet de Rosevilie, 29. 
Agrigentum, 11. 
Allen, 119. 

American Public Health Associa- 
tion, 210. 
Anel, 24. 

Annandale, 2S5, 322, 330. 
Anthoine, 150. 
Arcaeus, 17. 
Aristotle, 18. 

Arloing, 118. 122, 179, 203. 
Arnold, 259. 
Ashhurst, 336. 

Bantock, 238. 

Barton, 336. 

Baumgarten, 43, 63. 

Bataille, 97. 

Bayard, 27, 120. 

Baxter, 122, 123. 

Beauperthius, 29. 

Beck, 170. 

Behring, 67, 70, 71, 75, 76, 146 

150, 157, 158,198,216,295. 
Bell, 26, 27, 
Bellosti Augustin, 23. 
Bergmann, Sh 54» 3io» 3^1? 3I4- 



Berkley, 28. 
Berlioz, 206. 

Bernays, 191, 318, 324, 344. 
Besclin, 149. 
Beu, 199. 
Bilgner, 24, 27. 
Billroth, 244, 279, 330. 
Binz, 25. 
Bitter, 70. 
Blanc, 206. 
Blondus, Michel, 14. 
Blount, 98. 
Blunt, 91. 
Blythe, 122. 
Bochefontaine, 25. 
Boer, 100. 
Bolton, 121, 123. 
Booerhave, 24. 
Bourget, 182. 
Boyle, Robett, 20. 
Bradford, 325, 342. 
Braun, 271. 
Braunschweig, 59. 
Brieger, 51, 56,80, 104, 
Brignot, 244. 
Brodnax, 199. 

Broome, 196, 197, 318, 325, 326 
344. 



346 



Browning, 315. 

Brugnatelli, 56. 
Bruno, 13. 
Bryant, 322, 331. 
Buchholtz, 108, 109, 113. 
Budd, 33. 

Buechner, 53, 59, 60, 63, 67, 70 
72, 76, 158. 

Cadcac, 87, 118, 149, 162. 

Cadet de Gassicourt, 53. 

Caignard de la Tour, 6, 28, 29, 32 

Callender, 185. 

Calvert, 32, 33, 120, 122, 123. 

Cannon, 43, 

Catlani, 75, 76, 79, 80, 228. 

Chaumette, 27, 120. 

Chautard, 156. 

Cerna, lot, 103. 

Cheyne, 84, 121. 

Chiene, 331. 

Christmann, 70, 151. 

Christmas, 166, 170. 

Cohn, 41. 

Colasanti, 147. 

Colbatch, 21, 27. 

Col de Villars, 24. 

Cornevin, 118, 122, 179, 203. 

Cozzolini, 164. 

Cunningham, Lewis and D., 66 

84. 

Curtmann, 100. 
Czerni, 297, 329. 

Dann, 53. 
Darzens, 172. 



Davainne, 30, 32, 122, 123. 

Davidsohn, 286. 

D*Egineta, 13. 

Delacroix, 16, 97, 129, 211. 

De la Tour, 6, 34. 

Delavan, 98. 

Demosthenes, 253. 

Dennis, 245. 

De Ruyter, 314. 

De Vigo, 14. 

Desnos, 181. 

D.sneuf, 184. 

Doering, 177. 

Donne, 29. 

Dougall, 108, 122. 

Douglass, 123. 

Downes, 91. 

Draer, 205. 

Dubois, 172. 

Duclaux, 168. 

Dulerly, 171. 

Dujardin-Beaumetz, 30, 127. 

Duggan, 117. 

Dumas, 120. 

Dupre, 53, 54. 

Dupuy, 53. 

Duroy, 157. 

Eberth, 42, 229. 
Emmerich, 70, 71, 75, 148. 
Empedodes, 11. 
Empis, 184. 
Erand, 98. 
Esmarch, 317, 330, 
Ezechias, 12. 



347 



Faktor, 99. 

Fassbender, 55. 

Ferran, 154. 

Feuerbringer, 262, 30 t, 303. 

Fischer, 97, 122, 145. 

Fisher, 128. 

Fleck, 108, 

Flint, 187. 

Fodor, 66, 70. 

Foote, 165. 

Forster, 1 04. 

Fortchinskey, 229. 

Fowler, 247. 

Fox, 214, 

Fraenkel, 76, 229. 

Frisch, 87. 

Fritsch, 182. 

Fritze, 27. 

Gaillard, 91. 

Gaffky, 43 

Garrigues, 269. 

Gaspard, 53. 

Gaston, 342. 

Gautier, 48. 

Gay Dussac, 28, 29. 

Geister, 91. 

Geppeit, 138. 

Gerrish, 325, 341. 

Gersier, 227, 248, 253, 255, 256 
275,283, 292, 295, 298, 302, 305 
306,308,311,316,318,335. 

Ghriskey, 136, 176, 259, 261, 285 

Globig, 88. 

Goldmann, 103. 

Goldsghmitt, 177. 



Gordon, 259. 
Gottstein, t6i. 
Graucher, 156. 
Grohmann, 66. 
Grube, 108. 
Guareschi, 56. 
Gubler, 184. 
Guiboust, 27, 120. 
Gschiedlon, 66. 
Guinard, 162. 
Gunning, 55. 
Gussenbauer, 329. 
Guttman, 145, 205. 
Guyton, 128. 

Hallibuston, 70. 
Hallier, 25. 
Halsted, 127. 
Hamilton, 237. 
Hansen, 41, 212. 
Hardenbtrgh, 188. 
Harder, 196. 
Hardesty, 196. 
Hare, 121, 188 
Harris, 260. 
Harrison, 333. 
Haschimodo, 95. 
Haukin, 56, 70, 71. 
Heifer ich, 310. 
Helmholtz, 29, 30. 
Heister, 24. 
Hemmer, 54. 
Hennemann, 54. 
Herbot, 25. 
Hildebrandt, 60. 
Hirne,^i27. 



348 



Hitchmann, i88. 
Hock, 215. 
Hoffa, s6. 
Horsley, 322, 332. 
Hoppe-Seiler, 122. 
Huenefeld, 54. 
Hueppe, 107, 204, 206. 
Hueter, 40. 
Hugge, 122. 
Hunt, 323, 338. 
Hunter, 26. 

International Congress of Physi- 
cians and Surgeons at Brussels, 
267, 268. 

Jaeger, 116, 176. 
Jasuhara, 75, 76. 
Jeannel, 15. 
Jenner, 74. 
Johnson, 113, 227. 
Jones Beuce, 54. 

Kaposi, 215. 

Karlow, 231. 

Keen, 127, 298, 323, 334. 

Kelly, 136, 176, 259, 261, 262,264 

285, 303. 
Kern, 27. 
Kerner, 53. 
King of Servia, 249. 
Kingzett, 188. 
Kirchner, 130. 
Kitasato, 75, 76, 80, 95^ 99» ^S 

116, 132, 152, 161, 167, 171,173 

174, 175, 184,199,211. 



Klebbs, 42. 

Klein, 96, 140. 

Klemperer, 76. 

Koch, 40, 41, 49, 56, 89, 90, 91, 95 
96, 97, 99, 105, 108, 116, 121 
122, 123, 129, 130, 133, 135, 149 
I53.I57. 166, 167, 173, 174, 175 
184, 198, 210, 216, 218, 219, 220 
229, 279. 

Koch, E., 188. 

Kocher, 284, 293, 296, 303, 306 
308, 312, 314. 

Kolbe, 183, 184. 

Kopp, 151. 

Kresin, 145. 

Kronacher, 148. 

Kuemmel, 282, 301, 302. 

Kuhn, 97. 

Lafage, 150. 

Lanfranc, 13. 

Langenbeck, 28, 330. 

Langenbuch, 157. 

Laplace, 122, 142, 145. 

Laser, 188. 

Laveran, 42. 

Lazerus, 64. 

LeBoeuf, 20. 

Leeuwenhock, 19, 28. 

Lefort, 97. 

Lemaine, 33, 120. 

Leuret, 53. 

Leviticus, 11. 

Limpricht, 183. 

Lindemann, 79. 

Lister, 4, 21, 27, 29, 34, 35^ 3^, 37 



249 



38, 39> 40, 41, 43f "2, 120, 125 
126, 140, 142, 158, 163,218,241 
278, 279, 285, 305, 306, 318. 

Loejffler, 42. ^ 

Loew, 70. 

Loewenthal, 186. 

Lombard, 26. 

Lomboso, 56. 

Longard, 85. 

Lucatello, 229. 

Lukaschewitsch, 168. 



108, 109, 113, 116, 122, 127,131 
i35» i47» 153. 162, 164, 167, 173 
i75» 176, 179' 198, 199^203,212 
217, 218. 

Morand, 52. 

Morse, 195. 

Morton, 245. 

Moses, II. 

Mosetig von Moorhoff, 313, 327 

Mosso, 56. 

Mueller, 25. 



MacknofF, 59. 

Magatus, 19. 

Magendie, 53. 

Maison d'Accouchments, 267. 

Malet, 87. 

Marks, J 6, 318. 

Martin, 43, 318. 

Mastin 95, 318, 324, 340. 

Mater y Hospital, New York 

270. 
Mayer, 25. 
Mayow, 27. 

McClintock, 70, 77, 96, 285. 
McDowell, 235. 
McGraw, 324, 341, 
Meigs, 26 . 
Menz, 202. 
Meyer, 54, 215,229. 
Merk, 100. 
Mermann, 270, 271. 
Meunier, 118, 149. 
Michael, 343. 
Mikulicz, 312. 
Miquel, 88, 97, 99, 100, 105, 107 



Neisser, 41, 158, 217. 
Nelaton, 97. 
Nenki, 53, 55. 
Neuber, 282. 
Neudorfer 22, 143, 158. 
Neuhaus, 225. 
Newton, 3. 
Nicati, 123. 
Nicolaier, 43. 
Nissen, 70, 93, 1 1 7. 
Nold, 196. 
Novy, 70, 77. 
Nussbaum, 242, 310. 
Nuttall, 66. 

Oatman, 196. 
Obermeyer, 41. 
Ogata, 75, 76. 
Ogston, 84, 184. 
Ohmann-Dumesnil, 192. 
Orfila, 53. 
Orthenberger, 67, 
Oswald i38. 



350 



Palmer, 333. 

Panum, 31. 54. 

Paracelsus, 15. 

Pare, 15, 26, 27. 

Park, 100, i77,323» 33^- 

Parmanus, 24. 

Parisi, 25. 

Parset, 84. 

Pasteur, 30, 32, 33, 34, 35, 40, 41 

42, 75, 241, 299. 
Paul, 90. 
Patt, 25. 
Pekelhomig, 70. 
Pepper, 12,44. 
Perci, 26. 
Personne, 127. 
Perret, 1 50. 
Pertij, 31. 
Petri, 199. 
Pfeiffer, 43. 
Pfiuhl, 116. 

Pharmaceutische Zeitung, 178. 
Pippingskoeld, 270. 
Playfair, 259. 
Pollender, 30. 
PoUi, 25, 31, 201, 203. 
Portes, M., 179. 
Prestley, 26. 
Price, 239. 
Pringle, 25. 
Prosskauer, 128, I2q. 
Prudden, 87. 

Quinke, 184. 
R^nke, 216. 



Raschig, 143. 

Rayer, 30, 32. 

Reiche, 186. 

Reynier, 187. 

Ribbert, 59, 84. 

Richter, 26. 

Riedlin, 100 149, 159. 

Rietch, 123. 

Robb, 136, 176, 259, 261, 285. 

Roberts, 177. 

Robin, 31, 160. 

Rogerius, 13. 

Rohe, 90, 129. 

Rosenbach, 122. 

Rosenthal, 113. 

Roth, 59. 

Roux, 76, 153. 

R utter, 260. 

Salkowski, 108, 130. 
Salmon, 79. 
Schede, 279, 312. 
Schill, 97, 123, 145. 
Schimmelbusch, 59, 286, 287, 289 

290, 291, 320. 
Schlange, 319. 
Schmidt, 54, 66. 
Schmiedeberg, 31, 54. 
Schroeder, 31. 
Schroeter, 122. 
Schulze, 28, 29, 30, 34. 
Schumann, 53. 
Schutz, 42. 

Schwan, 29, 30, 34, 39, 40, 241. 
Schwartz, 228. 
Schweninger, 54. 



351 



Scrivnerj 196. 

Seibel, 160. 

Seitz, 210. 

Selmi, 52, 55. 

Semmelweiss, 271. 

Senn, 318, 323, 334. 

Sertuerner, 54. 

Sevet, 120. 

Shimwell, 155, 156. 

Shmitt, 76. 

Sivet, 27. 

Sittmann, 67. 

Socin, 279, 330. 

Solis-Cohen, 114. 

Solomon, 12. 

Sonnenschein, 55. 

Suergtiersky, 107. 

vSpence, 242. 

Spengler, 98, 310. 

Squibb, 103, 107, 115, 124, 159 
160, 165, 178, 205, 208. 

StefFen, 104. 

Steinmetz, 70. 

Sternberg, 42, 63, 76, 87, 88, 91 
100, 109, 112, 113, 122, 123, 127 
^33y 145, 152, i55> i59>i66, 174 
i75» i79> ^^4? 201, 209,210,211 
225. 

Stich, 54. 

Stille, 98. 

Stilling, 100. 

Stimson, 123, 224, 280. 



Tchourilow, iiS- 

Theophrastus, . 

Thiersch, 185, 279. 

Thinot, 210. 

Thomas, 118, 122, 179, 203. 

Thornton, 238, 24.6. 

Tilanus, 158. 

Tizxoni, 75, 76, 79, 80, 228 

Tour, 6. 

Traube, 66. 

Trousseau. 53. 

Tsuboi, 70, 

Tyndall, 91, 287. 

Unna, 180. 
Ure, 29, 30. 

Van Ermengem, 93, 132. 
Vaughan, 56, 68, 69, 70, 71, 72, 73 

77r 78, 79. 80, 84. 
Velpeau, 157. 
Vicary, 17. 
Vicquerat, 303. 
Vig^o, 14. 
Voelsch, 88. 
Voit, 67. 

Volkmann, 243, 278, 288. 
Von Haller, 52. 
Von Dusch, 31. 
Von Kern, 27. 
Von Mering, 104. 
Von Walther, 27. 



Tait, 238. 

Tavel, 287, 303, 305, 308. 

Tassinari, 217. 



Wagner, 231. 
Walb, 113. 
Walthard, 308. 



m 



Walther, 27. 

WhartOD, 343. 

Wassermann, 80. 

Weber, 54. 

Weigert, 41,63. 

Weiss, 53. 

Welch, 140, 176, 285, 303. 

Wells, 35 

Westrumb, 54. 

Weyl, 64. 

White, 238, 245, 251, 335. 

Williams, 196. 

Wiseman, 20. 

Withauer, 205. 

WolfFhuegel, 89, 90 



Wojtaszek, 208. 
Wood, 98, 127, 185, 213. 

Wooldridge, 73, 77, 80. 
Wurtz, 17. 
Wysokowicz, 66, 84. 

Yandell, 324, 341. 

Yarnall, 194. 

Yersine, 88, 123, 145, 149, 171 
216. 

Zimmermann, 285, 305, 306. 
Zirmssen, 124. 
Zuelser, 55. 
Zuntz, 70. 



